Robotic surgical systems with mechanisms for scaling surgical tool motion according to tissue proximity

ABSTRACT

A surgical system is disclosed including a surgical tool, a motor operably coupled to the surgical tool, and a control circuit coupled to the motor. The control circuit is configured to receive an instrument motion control signal indicative of a user input, cause the motor to move the surgical tool in response to the instrument motion control signal, receive an input signal indicative of a distance between the surgical tool and tissue, and scale the movement of the surgical tool to the user input in accordance with the input signal.

BACKGROUND

Surgical systems often incorporate an imaging system, which can allowthe clinician(s) to view the surgical site and/or one or more portionsthereof on one or more displays such as a monitor. The display(s) can belocal and/or remote to a surgical theater. An imaging system can includea scope with a camera that views the surgical site and transmits theview to a display that is viewable by a clinician. Imaging systems canbe limited by the information that they are able to recognize and/orconvey to the clinician(s). For example, certain concealed structures,physical contours, and/or dimensions within a three-dimensional spacemay be unrecognizable intraoperatively by certain imaging systems.Additionally, certain imaging systems may be incapable of communicatingand/or conveying certain information to the clinician(s)intraoperatively.

Robotic systems can be actuated or remotely-controlled by one or moreclinicians positioned at control consoles. Input motions at the controlconsole(s) can correspond to actuations of a robotic arm and/or arobotic tool coupled thereto. In various instances, the robotic systemand/or the clinician(s) can rely on views and/or information provided byan imaging system to determine the desired robotic actuations and/or thecorresponding suitable input motions. The inability of certain imagingsystems to provide certain visualization data and/or information maypresent challenges and/or limits to the decision-making process of theclinician and/or the controls for the robotic system.

SUMMARY

In various embodiments, a surgical system is disclosed including asurgical tool, a motor operably coupled to the surgical tool, and acontrol circuit coupled to the motor. The control circuit is configuredto receive an instrument motion control signal indicative of a userinput, cause the motor to move the surgical tool in response to theinstrument motion control signal, receive an input signal indicative ofa distance between the surgical tool and tissue, and scale the movementof the surgical tool to the user input in accordance with the inputsignal.

In various embodiments, a surgical system is disclosed including asurgical tool, a motor operably coupled to the surgical tool, and acontrol circuit coupled to the motor. The control circuit is configuredto receive an instrument motion control signal indicative of a userinput, cause the motor to move the surgical tool in response to theinstrument motion control signal, determine a distance between thesurgical tool and tissue, and scale the movement of the surgical tool tothe user input in accordance with the distance.

In various embodiments, a surgical system is disclosed including asurgical tool, a motor operably coupled to the surgical tool, and acontrol circuit coupled to the motor. The control circuit is configuredto receive an instrument motion control signal indicative of a userinput, cause the motor to move the surgical tool in response to theinstrument motion control signal, receive an input signal indicative ofa distance between the surgical tool and tissue, and select between agross motion mode and a fine motion mode of the surgical tool based ondistance between the surgical tool and the tissue.

FIGURES

The novel features of the various aspects are set forth withparticularity in the appended claims. The described aspects, however,both as to organization and methods of operation, may be best understoodby reference to the following description, taken in conjunction with theaccompanying drawings in which:

FIG. 1 is a plan view of a robotic surgical system being used to performa surgery, according to at least one aspect of the present disclosure.

FIG. 2 is a perspective view of a surgeon's control console of therobotic surgical system of FIG. 1, according to at least one aspect ofthe present disclosure.

FIG. 3 is a diagram of a robotic surgical system, according to at leastone aspect of the present disclosure.

FIG. 4 is a perspective view of a surgeon's control console of a roboticsurgical system, according to at least one aspect of the presentdisclosure.

FIG. 5 is a perspective view of an input control device at a surgeon'scontrol console, according to at least one aspect of the presentdisclosure.

FIG. 6 is a perspective view of an input control device for a roboticsurgical system, according to at least one aspect of the presentdisclosure.

FIG. 7 is a perspective view of an end effector of a surgical tooloperably controllable by control motions supplied to the input controldevice of FIG. 6, according to at least one aspect of the presentdisclosure.

FIG. 8 is a schematic of a surgical visualization system including animaging device and a surgical device, the surgical visualization systemconfigured to identify a critical structure below a tissue surface,according to at least one aspect of the present disclosure.

FIG. 9 is a schematic of a control system for a surgical visualizationsystem, according to at least one aspect of the present disclosure.

FIG. 9A is a schematic of a control system for a surgical visualizationsystem, according to at least one aspect of the present disclosure.

FIG. 10A illustrates a control circuit configured to control aspects ofa surgical visualization system, according to at least one aspect of thepresent disclosure.

FIG. 10B illustrates a combinational logic circuit configured to controlaspects of a surgical visualization system, according to at least oneaspect of the present disclosure.

FIG. 10C illustrates a sequential logic circuit configured to controlaspects of a surgical visualization system, according to at least oneaspect of the present disclosure.

FIG. 11 is a schematic depicting triangularization between the surgicaldevice, the imaging device, and the critical structure of FIG. 8 todetermine a depth d_(A) of the critical structure below the tissuesurface, according to at least one aspect of the present disclosure.

FIG. 12 is a schematic of a surgical visualization system configured toidentify a critical structure below a tissue surface, wherein thesurgical visualization system includes a pulsed light source fordetermining a depth d_(A) of the critical structure below the tissuesurface, according to at least one aspect of the present disclosure.

FIG. 13 is a schematic of a surgical visualization system including animaging device and a surgical device, the surgical visualization systemconfigured to identify a critical structure below a tissue surface,according to at least one aspect of the present disclosure.

FIG. 13A is a schematic of a surgical visualization system utilizing acamera that is moved axially between a plurality of known positions todetermine a position of an embedded critical structure, according to atleast one aspect of the present disclosure.

FIG. 13B is a schematic of the surgical visualization system of FIG.13A, in which the camera is moved axially and rotationally between aplurality of known positions to determine a position of the embeddedcritical structure, according to at least one aspect of the presentdisclosure.

FIG. 13C is a schematic of a near infrared (NIR) time-of-flightmeasurement system configured to sense distance to a critical anatomicalstructure, the time-of-flight measurement system including a transmitter(emitter) and a receiver (sensor) positioned on a common device,according to at least one aspect of the present disclosure.

FIG. 13D is a schematic of an emitted wave, a received wave, and a delaybetween the emitted wave and the received wave of the NIR time-of-flightmeasurement system of FIG. 13C, according to at least one aspect of thepresent disclosure.

FIG. 13E illustrates a NIR time-of-flight measurement system configuredto sense a distance to different structures, the time-of-flightmeasurement system including a transmitter (emitter) and a receiver(sensor) on separate devices, according to one aspect of the presentdisclosure.

FIG. 13F is a schematic of a surgical visualization system including athree-dimensional camera, wherein the surgical visualization system isconfigured to identify a critical structure that is embedded withintissue, according to at least one aspect of the present disclosure.

FIGS. 13G and 13H are views of the critical structure taken by thethree-dimensional camera of FIG. 13F, in which FIG. 13G is a view from aleft-side lens of the three-dimensional camera and FIG. 13H is a viewfrom a right-side lens of the three-dimensional camera, according to atleast one aspect of the present disclosure.

FIG. 13I is a schematic of the surgical visualization system of FIG.13F, in which a camera-to-critical structure distance d_(w) from thethree-dimensional camera to the critical structure can be determined,according to at least one aspect of the present disclosure.

FIG. 13J is a schematic of a surgical visualization system utilizing twocameras to determine the position of an embedded critical structure,according to at least one aspect of the present disclosure.

FIG. 13K is a schematic of a structured light source for a surgicalvisualization system, according to at least one aspect of the presentdisclosure.

FIGS. 13L-13N depict illustrative hyperspectral identifying signaturesto differentiate anatomy from obscurants, wherein FIG. 13L is agraphical representation of a ureter signature versus obscurants, FIG.13M is a graphical representation of an artery signature versusobscurants, and FIG. 13N is a graphical representation of a nervesignature versus obscurants, according to at least one aspect of thepresent disclosure.

FIG. 14 is a logic flow diagram of a process for controlling themovement of a robotic surgical system, in accordance with at least oneaspect of the present disclosure.

FIG. 15 is a logic flow diagram of a process for controlling themovement of a robotic surgical system, in accordance with at least oneaspect of the present disclosure.

FIG. 16 is graph of the required force to be exerted on an input controldevice to move the robotic surgical system versus the proximity of asurgical tool end effector to a patient, in accordance with at least oneaspect of the present disclosure.

FIG. 17 is a logic flow diagram of a process for controlling avisualization system of a robotic surgical system, in accordance with atleast one aspect of the present disclosure.

FIG. 18 is a graph of the magnification of the visualization systemversus the distance between the robotic surgical system component andthe patient, in accordance with at least one aspect of the presentdisclosure.

FIG. 19 is a graph of the field of view (FOV) of the visualizationsystem versus the distance between the robotic surgical system componentand the patient, in accordance with at least one aspect of the presentdisclosure.

FIG. 20 is a perspective view of a robotic surgical system userinterface for tagging locations, in accordance with at least one aspectof the present disclosure.

FIG. 21 is an elevational view of a tagged zone defined via the userinterface, in accordance with at least one aspect of the presentdisclosure.

FIG. 22 is a logic flow diagram of a process for controlling a roboticsurgical system according to whether a component thereof is positionedwithin a tagged zone, in accordance with at least one aspect of thepresent disclosure.

FIG. 23 is a logic flow diagram of a process for controlling themovement of a robotic surgical system according to camera magnification,in accordance with at least one aspect of the present disclosure.

FIG. 24 is a graph of a robotic surgical system movement scale factorversus camera magnification, in accordance with at least one aspect ofthe present disclosure.

FIG. 25 is a logic flow diagram of a process for controlling an endeffector, in accordance with at least one aspect of the presentdisclosure.

FIG. 25A is a logic flow diagram of a process for controlling an endeffector, in accordance with at least one aspect of the presentdisclosure.

FIG. 26 is a logic flow diagram of a process for controlling an endeffector, in accordance with at least one aspect of the presentdisclosure.

FIG. 26A is a logic flow diagram of a process for controlling an endeffector, in accordance with at least one aspect of the presentdisclosure.

FIG. 27 is a perspective view of an end effector comprising an indicatorconfigured to signal the lock state of the surgical tool, in accordancewith at least one aspect of the present disclosure.

FIG. 28 is a graph illustrating four motion scaling profiles, inaccordance with at least one aspect of the present disclosure.

FIG. 29 is a motion scaling profile selector, in accordance with atleast one aspect of the present disclosure.

FIG. 30 is a lookup table stored in a memory, in accordance with atleast one aspect of the present disclosure.

FIG. 31 is pedal assembly, in accordance with at least one aspect of thepresent disclosure.

FIG. 32 is a logic flow diagram of a process for selecting betweenmotion scaling profiles for a surgical tool, in accordance with at leastone aspect of the present disclosure.

FIG. 33 is a logic flow diagram of a process for selecting betweenmotion scaling profiles for a surgical tool, in accordance with at leastone aspect of the present disclosure.

FIG. 34 is a logic flow diagram of a process for selecting betweenmotion scaling profiles for a surgical tool, in accordance with at leastone aspect of the present disclosure.

DESCRIPTION

Applicant of the present application owns the following U.S. PatentApplications, filed on Mar. 15, 2019, each of which is hereinincorporated by reference in its entirety:

-   -   Attorney Docket No. END9052USNP1/180620-1, titled INPUT CONTROLS        FOR ROBOTIC SURGERY;    -   Attorney Docket No. END9052USNP2/180620-2, titled DUAL MODE        CONTROLS FOR ROBOTIC SURGERY;    -   Attorney Docket No. END9052USNP3/180620-3, titled MOTION CAPTURE        CONTROLS FOR ROBOTIC SURGERY;    -   Attorney Docket No. END9053USNP2/180621-2, titled ROBOTIC        SURGICAL SYSTEMS WITH MECHANISMS FOR SCALING CAMERA        MAGNIFICATION ACCORDING TO PROXIMITY OF SURGICAL TOOL TO TISSUE;    -   Attorney Docket No. END9053USNP3/180621-3, titled ROBOTIC        SURGICAL SYSTEMS WITH SELECTIVELY LOCKABLE END EFFECTORS;    -   Attorney Docket No. END9053USNP4/180621-4, titled SELECTABLE        VARIABLE RESPONSE OF SHAFT MOTION OF SURGICAL ROBOTIC SYSTEMS;    -   Attorney Docket No. END9054USNP1/180622-1, titled SEGMENTED        CONTROL INPUTS FOR SURGICAL ROBOTIC SYSTEMS;    -   Attorney Docket No. END9055USNP1/180623-1, titled ROBOTIC        SURGICAL CONTROLS HAVING FEEDBACK CAPABILITIES;    -   Attorney Docket No. END9055USNP2/180623-2, titled ROBOTIC        SURGICAL CONTROLS WITH FORCE FEEDBACK; and    -   Attorney Docket No. END9055USNP3/180623-3, titled JAW        COORDINATION OF ROBOTIC SURGICAL CONTROLS.

Applicant of the present application also owns the following U.S. PatentApplications, filed on Sep. 11, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 16/128,179, titled SURGICAL        VISUALIZATION PLATFORM;    -   U.S. patent application Ser. No. 16/128,180, titled CONTROLLING        AN EMITTER ASSEMBLY PULSE SEQUENCE;    -   U.S. patent application Ser. No. 16/128,198, titled SINGULAR EMR        SOURCE EMITTER ASSEMBLY;    -   U.S. patent application Ser. No. 16/128,207, titled COMBINATION        EMITTER AND CAMERA ASSEMBLY;    -   U.S. patent application Ser. No. 16/128,176, titled SURGICAL        VISUALIZATION WITH PROXIMITY TRACKING FEATURES;    -   U.S. patent application Ser. No. 16/128,187, titled SURGICAL        VISUALIZATION OF MULTIPLE TARGETS;    -   U.S. patent application Ser. No. 16/128,192, titled        VISUALIZATION OF SURGICAL DEVICES;    -   U.S. patent application Ser. No. 16/128,163, titled OPERATIVE        COMMUNICATION OF LIGHT;    -   U.S. patent application Ser. No. 16/128,197, titled ROBOTIC        LIGHT PROJECTION TOOLS;    -   U.S. patent application Ser. No. 16/128,164, titled SURGICAL        VISUALIZATION FEEDBACK SYSTEM;    -   U.S. patent application Ser. No. 16/128,193, titled SURGICAL        VISUALIZATION AND MONITORING;    -   U.S. patent application Ser. No. 16/128,195, titled INTEGRATION        OF IMAGING DATA;    -   U.S. patent application Ser. No. 16/128,170, titled        ROBOTICALLY-ASSISTED SURGICAL SUTURING SYSTEMS;    -   U.S. patent application Ser. No. 16/128,183, titled SAFETY LOGIC        FOR SURGICAL SUTURING SYSTEMS;    -   U.S. patent application Ser. No. 16/128,172, titled ROBOTIC        SYSTEM WITH SEPARATE PHOTOACOUSTIC RECEIVER; and    -   U.S. patent application Ser. No. 16/128,185, titled FORCE SENSOR        THROUGH STRUCTURED LIGHT DEFLECTION.

Applicant of the present application also owns the following U.S. PatentApplications, filed on Mar. 29, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 15/940,627, titled DRIVE        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. patent application Ser. No. 15/940,676, titled AUTOMATIC        TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. patent application Ser. No. 15/940,711, titled SENSING        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and    -   U.S. patent application Ser. No. 15/940,722, titled        CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF        MONO-CHROMATIC LIGHT REFRACTIVITY.

Before explaining various aspects of a robotic surgical platform indetail, it should be noted that the illustrative examples are notlimited in application or use to the details of construction andarrangement of parts illustrated in the accompanying drawings anddescription. The illustrative examples may be implemented orincorporated in other aspects, variations, and modifications, and may bepracticed or carried out in various ways. Further, unless otherwiseindicated, the terms and expressions employed herein have been chosenfor the purpose of describing the illustrative examples for theconvenience of the reader and are not for the purpose of limitationthereof. Also, it will be appreciated that one or more of thefollowing-described aspects, expressions of aspects, and/or examples,can be combined with any one or more of the other following-describedaspects, expressions of aspects, and/or examples.

Before explaining various aspects of a robotic surgical platform indetail, it should be noted that the illustrative examples are notlimited in application or use to the details of construction andarrangement of parts illustrated in the accompanying drawings anddescription. The illustrative examples may be implemented orincorporated in other aspects, variations, and modifications, and may bepracticed or carried out in various ways. Further, unless otherwiseindicated, the terms and expressions employed herein have been chosenfor the purpose of describing the illustrative examples for theconvenience of the reader and are not for the purpose of limitationthereof. Also, it will be appreciated that one or more of thefollowing-described aspects, expressions of aspects, and/or examples,can be combined with any one or more of the other following-describedaspects, expressions of aspects, and/or examples.

Robotic Systems

An exemplary robotic system 110 is depicted in FIG. 1. The roboticsystem 110 is a minimally invasive robotic surgical (MIRS) systemtypically used for performing a minimally invasive diagnostic orsurgical procedure on a patient 112 who is lying down on an operatingtable 114. The robotic system 110 includes a surgeon's console 116 foruse by a surgeon 118 during the procedure. One or more assistants 120may also participate in the procedure. The robotic system 110 canfurther include a patient side cart 122, i.e. a surgical robot, and anelectronics cart 124. The surgical robot 122 can manipulate at least oneremovably coupled tool assembly 126 (hereinafter referred to as a“tool”) through a minimally invasive incision in the body of the patient112 while the surgeon 118 views the surgical site through the console116. An image of the surgical site can be obtained by an imaging devicesuch as a stereoscopic endoscope 128, which can be manipulated by thesurgical robot 122 to orient the endoscope 128. Alternative imagingdevices are also contemplated.

The electronics cart 124 can be used to process the images of thesurgical site for subsequent display to the surgeon 118 through thesurgeon's console 116. In certain instances, the electronics of theelectronics cart 124 can be incorporated into another structure in theoperating room, such as the operating table 114, the surgical robot 122,the surgeon's console 116, and/or another control station, for example.The number of robotic tools 126 used at one time will generally dependon the diagnostic or surgical procedure and the space constraints withinthe operating room among other factors. If it is necessary to change oneor more of the robotic tools 126 being used during a procedure, anassistant 120 may remove the robotic tool 126 from the surgical robot122 and replace it with another tool 126 from a tray 130 in theoperating room.

Referring primarily to FIG. 2, the surgeon's console 116 includes a lefteye display 132 and a right eye display 134 for presenting the surgeon118 with a coordinated stereo view of the surgical site that enablesdepth perception. The console 116 further includes one or more inputcontrol devices 136, which in turn cause the surgical robot 122 tomanipulate one or more tools 126. The input control devices 136 canprovide the same degrees of freedom as their associated tools 126 toprovide the surgeon with telepresence, or the perception that the inputcontrol devices 136 are integral with the robotic tools 126 so that thesurgeon has a strong sense of directly controlling the robotic tools126. To this end, position, force, and tactile feedback sensors may beemployed to transmit position, force, and tactile sensations from therobotic tools 126 back to the surgeon's hands through the input controldevices 136. The surgeon's console 116 can be located in the same roomas the patient 112 so that the surgeon 118 may directly monitor theprocedure, be physically present if necessary, and speak to an assistant120 directly rather than over the telephone or other communicationmedium. However, the surgeon 118 can be located in a different room, acompletely different building, or other remote location from the patient112 allowing for remote surgical procedures. A sterile field can bedefined around the surgical site. In various instances, the surgeon 118can be positioned outside the sterile field.

Referring again to FIG. 1, the electronics cart 124 can be coupled withthe endoscope 128 and can include a processor to process captured imagesfor subsequent display, such as to a surgeon on the surgeon's console116, or on another suitable display located locally and/or remotely. Forexample, when the stereoscopic endoscope 128 is used, the electronicscart 124 can process the captured images to present the surgeon withcoordinated stereo images of the surgical site. Such coordination caninclude alignment between the opposing images and can include adjustingthe stereo working distance of the stereoscopic endoscope. As anotherexample, image processing can include the use of previously-determinedcamera calibration parameters to compensate for imaging errors of theimage capture device, such as optical aberrations, for example. Invarious instances, the robotic system 110 can incorporate a surgicalvisualization system, as further described herein, such that anaugmented view of the surgical site that includes hidden criticalstructures, three-dimensional topography, and/or one or more distancescan be conveyed to the surgeon at the surgeon's console 116.

FIG. 3 diagrammatically illustrates a robotic surgery system 150, suchas the MIRS system 110 (FIG. 1). As discussed herein, a surgeon'sconsole 152, such as the surgeon's console 116 (FIGS. 1 and 2), can beused by a surgeon to control a surgical robot 154, such as the surgicalrobot 122 (FIG. 1), during a minimally invasive procedure. The surgicalrobot 154 can use an imaging device, such as a stereoscopic endoscope,for example, to capture images of the surgical site and output thecaptured images to an electronics cart 156, such as the electronics cart124 (FIG. 1). As discussed herein, the electronics cart 156 can processthe captured images in a variety of ways prior to any subsequentdisplay. For example, the electronics cart 156 can overlay the capturedimages with a virtual control interface prior to displaying the combinedimages to the surgeon via the surgeon's console 152. The surgical robot154 can output the captured images for processing outside theelectronics cart 156. For example, the surgical robot 154 can output thecaptured images to a processor 158, which can be used to process thecaptured images. The images can also be processed by a combination ofthe electronics cart 156 and the processor 158, which can be coupledtogether to process the captured images jointly, sequentially, and/orcombinations thereof. One or more separate displays 160 can also becoupled with the processor 158 and/or the electronics cart 156 for localand/or remote display of images, such as images of the surgical site, orother related images.

The reader will appreciate that various robotic tools can be employedwith the surgical robot 122 and exemplary robotic tools are describedherein. Referring again to FIG. 1, the surgical robot 122 shown providesfor the manipulation of three robotic tools 126 and the imaging device128, such as a stereoscopic endoscope used for the capture of images ofthe site of the procedure, for example. Manipulation is provided byrobotic mechanisms having a number of robotic joints. The imaging device128 and the robotic tools 126 can be positioned and manipulated throughincisions in the patient so that a kinematic remote center or virtualpivot is maintained at the incision to minimize the size of theincision. Images of the surgical site can include images of the distalends of the robotic tools 126 when they are positioned within thefield-of-view (FOV) of the imaging device 128. Each tool 126 isdetachable from and carried by a respective surgical manipulator, whichis located at the distal end of one or more of the robotic joints. Thesurgical manipulator provides a moveable platform for moving theentirety of a tool 126 with respect to the surgical robot 122, viamovement of the robotic joints. The surgical manipulator also providespower to operate the robotic tool 126 using one or more mechanicaland/or electrical interfaces. In various instances, one or more motorscan be housed in the surgical manipulator for generating controlsmotions. One or more transmissions can be employed to selectively couplethe motors to various actuation systems in the robotic tool.

The foregoing robotic systems are further described in U.S. patentapplication Ser. No. 15/940,627, titled DRIVE ARRANGEMENTS FORROBOT-ASSISTED SURGICAL PLATFORMS, filed Mar. 29, 2018, which isincorporated by reference herein in its entirety. Alternative roboticsystems are also contemplated.

Referring now to FIG. 4, a surgeon's console, or control unit, 250 isshown. The surgeon's console 250 can be used in connection with arobotic system to control any two surgical tools coupled to the roboticsystem. The surgical tools can be controlled by the handle assemblies256 of the surgeon's console 250. For example, the handle assemblies 256and robotic arms have a master-slave relationship so that movement ofthe handle assemblies 256 produces a corresponding movement of thesurgical tools. A controller 254 receives input signals from the handleassemblies 256, computes a corresponding movement of the surgical tools,and provides output signals to move the robotic arms and the surgicaltools.

The handle assemblies 256 are located adjacent to a surgeon's chair 258and coupled to the controller 254. The controller 254 may include one ormore microprocessors, memory devices, drivers, etc. that convert inputinformation from the handle assemblies 256 into output control signalswhich move the robotic arms and/or actuate the surgical tools. Thesurgeon's chair 258 and the handle assemblies 256 may be in front of avideo console 248, which can be linked to an endoscope to provide videoimages of the patient. The surgeon's console 250 may also include ascreen 260 coupled to the controller 254. The screen 260 may displaygraphical user interfaces (GUIs) that allow the surgeon to controlvarious functions and parameters of the robotic system.

Each handle assembly 256 includes a handle/wrist assembly 262. Thehandle/wrist assembly 262 has a handle 264 that is coupled to a wrist266. The wrist 266 is connected to a forearm linkage 268 that slidesalong a slide bar 270. The slide bar 270 is pivotally connected to anelbow joint 272. The elbow joint 272 is pivotally connected to ashoulder joint 274 that is attached to the controller 254. The surgeonsitting at the surgeon's console 250 can provide input control motionsto the handle assemblies 256 to effect movements and/or actuations of asurgical tool communicatively coupled thereto. For example, the surgeoncan advance the forearm linkage 268 along the slide bar 270 to advancethe surgical tool toward a surgical site. Rotations at the wrist 266,elbow joint 272, and/or shoulder joint 274 can effect rotation and/orarticulation of the surgical tool about the corresponding axes. Therobotic system and surgeon's console 250 are further described in U.S.Pat. No. 6,951,535, titled TELE-MEDICINE SYSTEM THAT TRANSMITS AN ENTIRESTATE OF A SUBSYSTEM, which issued Oct. 4, 2005, the entire disclosureof which is incorporated by reference herein.

A handle assembly for use at a surgeon's console is further depicted inFIG. 5. The handle assembly of FIG. 5 includes a control input wrist 352and a touch sensitive handle 325. The control input wrist 352 is agimbaled device that pivotally supports the touch sensitive handle 325to generate control signals that are used to control a robotic surgicalmanipulator and the robotic surgical tools. A pair of control inputwrists 352 and touch sensitive handles 325 can be supported by a pair ofcontrol input arms in a workspace of the surgeon's console.

The control input wrist 352 includes first, second, and third gimbalmembers 362, 364, and 366, respectively. The third gimbal member 366 canbe rotationally mounted to a control input arm. The touch sensitivehandle 325 include a tubular support structure 351, a first grip 350A,and a second grip 350B. The first grip 350A and the second grip 350B aresupported at one end by the tubular support structure 351. The touchsensitive handle 325 can be rotated about axis G. The grips 350A, 350Bcan be squeezed or pinched together about the tubular support structure351. The “pinching” or grasping degree of freedom in the grips isindicated by arrows Ha and Hb.

The touch sensitive handle 325 is rotatably supported by the firstgimbal member 362 by means of a rotational joint 356 g. The first gimbalmember 362 is in turn, rotatably supported by the second gimbal member364 by means of the rotational joint 356 f. Similarly, the second gimbalmember 364 is rotatably supported by the third gimbal member 366 using arotational joint 356 e. In this manner, the control input wrist 352allows the touch sensitive handle 325 to be moved and oriented in theworkspace using three degrees of freedom.

The movements in the gimbals 362, 364, 366 of the control input wrist352 to reorient the touch sensitive handle 325 in space can betranslated into control signals to control a robotic surgicalmanipulator and the robotic surgical tools. The movements in the grips350A and 350B of the touch sensitive handle 325 can also be translatedinto control signals to control the robotic surgical manipulator and therobotic surgical tools. In particular, the squeezing motion of the grips350A and 350B over their freedom of movement indicated by arrows Ha andHb, may be used to control the end effectors of the robotic surgicaltools.

To sense the movements in the touch sensitive handle 325 and generatecontrols signals, sensors can be mounted in the handle 325 as well asthe first gimbal member 362 of the control input wrist 352. Exemplarysensors may be a pressure sensor, a Hall Effect transducer, apotentiometer, and/or an encoder, for example. The robotic surgicalsystems and handle assembly of FIG. 5 are further described in U.S. Pat.No. 8,224,484, titled METHODS OF USER INTERFACE WITH ALTERNATIVE TOOLMODE FOR ROBOTIC SURGICAL TOOLS, which issued Jul. 17, 2012, the entiredisclosure of which is incorporated by reference herein.

Existing robotic systems can incorporate a surgical visualizationsystem, as further described herein. In such instances, additionalinformation regarding the surgical site can be determined and/orconveyed to the clinician(s) in the surgical theater, such as to asurgeon positioned at a surgeon's console. For example, the clinician(s)can observe an augmented view of reality of the surgical site thatincludes additional information such as various contours of the tissuesurface, hidden critical structures, and/or one or more distances withrespect to anatomical structures. In various instances, proximity datacan be leveraged to improve one or more operations of the roboticsurgical system and or controls thereof, as further described herein.

Input Control Devices

Referring again to the robotic system 150 in FIG. 3, the surgeon'sconsole 152 allows the surgeon to provide manual input commands to thesurgical robot 154 to effect control of the surgical tool and thevarious actuations thereof. Movement of an input control device by asurgeon at the surgeon's console 152 within a predefined working volume,or work envelope, results in a corresponding movement or operation ofthe surgical tool. For example, referring again to FIG. 2, a surgeon canengage each input control device 136 with one hand and move the inputcontrol devices 136 within the work envelope to provide control motionsto the surgical tool. Surgeon's consoles (e.g. the surgeon's console 116in FIGS. 1 and 2 and the surgeon's console 250 in FIG. 4) can beexpensive and require a large footprint. For example, the working volumeof the input control device (e.g. the handle/wrist assembly 262 in FIG.4 and the control input wrist 352 and touch sensitive handle 325 in FIG.5) at the surgeon's consoles can necessitate a large footprint, whichimpacts the usable space in the operating room (OR), trainingmodalities, and cooperative procedures, for example. For example, such alarge footprint can preclude the option of having multiple controlstations in the OR, such as additional control stations for training oruse by an assistant. Additionally, the size and bulkiness of a surgeon'sconsole can be cumbersome to relocate within an operating room or movebetween operating rooms, for example.

Ergonomics is an important consideration for surgeons who may spend manyhours each day in surgery and/or at the surgeon's console. Excessive,repetitive motions during surgical procedures can lead to fatigue andchronic injury for the surgeon. It can be desirable to maintain acomfortable posture and/or body position while providing inputs to therobotic system. However, in certain instances, the surgeon's postureand/or position may be compromised to ensure proper positioning of asurgical tool. For example, surgeons are often prone to contort theirhands and/or extend their arms for long durations of time. In oneinstance, a gross control motion to move the surgical tool to thesurgical site may result in the surgeon's arms being uncomfortably toooutstretched and/or cramped uncomfortably close upon reaching thesurgical site. In certain instances, poor ergonomic posturing achievedduring the gross control motion may be maintained during a subsequentfine control motion, e.g. when manipulating tissue at the surgical site,which can further exasperate the poor ergonomics for the surgeon.Existing input control devices propose a one-size-fits-all approachregardless of the surgeon's anthropometrics; however, the ergonomicimpact to a surgeon can vary and certain body types may be more burdenedby the architecture of existing input control devices.

In certain instances, an input control device can be restrained withinthe work envelope that defines its range of motion. For example, thestructure of the surgeon's console and/or the linkages on the inputcontrol device can limit the range of the motion of the input controldevice. In certain instances, the input control device can reach the endof its range of motion before the surgical tool is appropriatelypositioned. In such instances, a clutching mechanism can be required toreposition the input control device within the work envelope to completethe positioning of the surgical tool. A hypothetical work envelope 280is shown in FIG. 4, for example. In various instances, the surgeon canbe required to actuate a clutch (often in the form of a foot pedal oradditional button on the handle of the input control device) totemporarily disengage the input control device from the surgical toolwhile the input control device is relocated to a desired position withinthe work envelope. This non-surgical motion by the surgeon can bereferred to as a “rowing” motion to properly reposition the inputcontrol device within the work envelope because of the arm motion of thesurgeon at the surgeon's console. Upon release of the clutch, themotions of the input control device can again control the surgical tool.

Clutching the input control device to maintain a suitable positionwithin the work envelope poses an additional cognitive burden to thesurgeon. In such instances, the surgeon is required to constantlymonitor the position and orientation of his/her hands relative to theboundaries of the work envelope. Additionally, the clutching or “rowing”motion can be tedious to the surgeon and such a monotonous, repetitivemotion does not match the analogous workflow of a surgical procedureoutside the context of robotic surgery. Clutching also requires thesurgeon to match a previous orientation of the handle when reengagingthe system. For example, upon completion of a complex range of motion inwhich the surgeon “rows” or clutches the input control device back to acomfortable, home position, the surgeon and/or surgical robot must matchthe orientation of the handle of the input control device in the homeposition to the previous orientation of the handle in the extendedposition, which can be challenging. and/or require complex logic and/ormechanics.

Requiring a clutch mechanism also limits the availability of controls onthe handle of the input control device. For example, a clutch actuatorcan take up valuable real estate on the handle, which cognitively andphysically limits the availability of other controls on the handle. Inturn, the complexity of other subsystems, such as a peddle board, isincreased and the surgeon may be required to utilize multiple inputsystems to complete a simple task.

Non-clutched alternatives to such input control devices can reduce thefootprint and cost of the surgeon's console, improve the surgeon'sergonomic experience, eliminate the physical and cognitive burdensassociated with clutching, and/or provide additional real estate on theinput control device for additional input controls, for example.Exemplary non-clutched input control devices are further describedherein. Such non-clutched input control devices can be employed with avariety of robotic systems. Moreover, as further described herein, thenon-clutched input control devices can leverage information from variousdistance determining subsystems also disclosed herein. For example,real-time structured light and three-dimensional shape modeling caninform the logic of such non-clutched input control devices such that afirst mode and/or first collection of controls are enabled outside apredefined distance from an anatomical surface and/or critical structureand a second mode and/or second collection of controls are enabledwithin a predefined distance of the anatomical structure and/or criticalstructure. Various tissue proximity applications are further describedherein.

Referring now to FIG. 6, an input control device 1000 is shown. Theinput control device 1000 is a clutchless input control device, asfurther described herein. The input control device 1000 can be utilizedat a surgeon's console or workspace for a robotic surgical system. Forexample, the input control device 1000 can be incorporated into asurgical system, such as the surgical system 110 (FIG. 1) or thesurgical system 150 (FIG. 3), for example, to provide control signals toa surgical robot and/or surgical tool coupled thereto based on a userinput. The input control device 1000 includes input controls for movingthe robotic arm and/or the surgical tool in three-dimensional space. Forexample, the surgical tool controlled by the input control device 1000can be configured to move and/or rotate relative to X, Y, and Z axes.

An exemplary surgical tool 1050 is shown in FIG. 7. The surgical tool1050 is a grasper that includes an end effector 1052 having opposingjaws, which are configured to releasably grab tissue. The surgical tool1050 can be maneuvered in three dimensional space by translating thesurgical tool 1050 along the X_(t), Y_(t), and Z_(t) axes thereof. Thesurgical tool 1050 also includes a plurality of joints such that thesurgical tool can be rotated and/or articulated into a desiredconfiguration. The surgical tool 1050 can be configured to rotate orroll about the X_(t) axis defined by the longitudinal shaft of thesurgical tool 1050, rotate or articulate about a first articulation axisparallel to the Y_(t) axis, and rotate or articulate about a secondarticulation axis parallel to the Z_(t) axis. Rolling about the X_(t)axis corresponds to a rolling motion of the end effector 1052 in thedirection R_(t), articulation about the first articulation axiscorresponds to a pitching motion of the end effector 1052 in thedirection P_(t), and articulation about the second articulation axiscorresponds to a yawing or twisting motion in the direction T_(t).

An input control device, such as the input control device 1000, forexample, can be configured to control the translation and rotation ofthe end effector 1052. To control such motion, the input control device1000 includes corresponding input controls. For example, the inputcontrol device 1000 includes at least six degrees of freedom of inputcontrols for moving the surgical tool 1050 in three dimensional spacealong the X_(t), Y_(t), and Z_(t) axes, for rolling the end effector1052 about the X_(t) axis, and for articulating the end effector 1052about the first and second articulation axes. Additionally, the inputcontrol device 1000 includes an end effector actuator for actuating theopposing jaws of the end effector 1052 to manipulate or grip tissue.

Referring again to FIG. 6, the input control device 1000 includes amulti-dimensional space joint 1006 having a central portion 1002supported on a base 1004. The base 1004 is structured to rest on asurface, such as a desk or work surface at a surgeon's console orworkspace. The base 1004 defines a circular base with a contoured edge;however, alternative geometries are contemplated. The base 1004 canremain in a fixed, stationary position relative to an underlying surfaceupon application of the input controls thereto. In certain instances,the base 1004 can be releasably secured and/or clamped to the underlyingsurface with fasteners, such as threaded fasteners, for example. Inother instances, fasteners may not be required to hold the base 1004 tothe underlying surface. In various instances, the base 1004 can includea sticky or tacking bottom surface and/or suction features (e.g. suctioncups or magnets) for gripping an underlying surface. In certaininstances, the base 1004 can include a ribbed and/or grooved bottomsurface for engaging a complementary underlying support surface tomaintain the base 1004 in a stationary state.

The space joint 1006 is configured to receive multi-dimensional manualinputs from a surgeon (e.g. the surgeon's hand or arm) corresponding tocontrol motions for the surgical tool 1050 in multi-dimensional space.The central portion 1002 of the space joint 1006 is configured toreceive input forces in multiple directions, such as forces along and/orabout the X, Y, and Z axes. The central portion 1002 can include araising, lowering, and rotating cylinder, shaft, or hemisphere, forexample, projecting from the base 1004. The central portion 1002 isflexibly supported relative to the base 1004 such that the cylinder,shaft, and/or hemisphere is configured to move or float within a smallpredefined zone upon receipt of force control inputs thereto. Forexample, the central portion 1002 can be a floating shaft that issupported on the base 1004 by one or more elastomeric members such assprings, for example. The central portion 1002 can be configured to moveor float within a predefined three-dimensional volume. For example,elastomeric couplings can permit movement of the central portion 1002relative to the base 1004; however, restraining plates, pins, and/orother structures can be configured to limit the range of motion of thecentral portion 1002 relative to the base 1004.

In various instances, the space joint 1006 includes a multi-axis forceand/or torque sensor arrangement 1048 (see FIG. 9) configured to detectthe input forces and moments applied to the central portion 1002 andtransferred to the space joint 1006. The sensor arrangement 1048 ispositioned on one or more of the surfaces at the interface between thecentral portion 1002 and the base 1004. In other instances, the sensorarrangement 1048 can be embedded in the central portion 1002 or the base1004. In still other instances, the sensor arrangement 1048 can bepositioned on a floating member positioned intermediate the centralportion 1002 and the base 1004.

The sensor arrangement 1048 can include one or more resistive straingauges, optical force sensors, optical distance sensors, miniaturecameras in the range of about 1.0 mm to about 3.0 mm in size, and/ortime of flight sensors utilizing a pulsed light source, for example. Inone aspect, the sensor arrangement 1048 includes a plurality ofresistive strain gauges configured to detect the different force vectorsapplied thereto. The strain gauges can define a Wheatstone bridgeconfiguration, for example. Additionally or alternatively, the sensorarrangement 1048 can include a plurality of optoelectronic sensors, suchas measuring cells comprising a position-sensitive detector illuminatedby a light-emitting element, such as an LED. Alternative force-detectingsensor arrangements are also contemplated. Exemplary multi-dimensionalinput devices and/or sensor arrangements are further described in thefollowing references, which are incorporated by reference herein intheir respective entireties:

-   -   U.S. Pat. No. 4,785,180, titled OPTOELECTRIC SYSTEM HOUSED IN A        PLASTIC SPHERE, issued Nov. 15, 1988;    -   U.S. Pat. No. 6,804,012, titled ARRANGEMENT FOR THE DETECTION OF        RELATIVE MOVEMENTS OR RELATIVE POSITION OF TWO OBJECTS, issued        Oct. 12, 2004;    -   European Patent Application No. 1,850,210, titled OPTOELECTRONIC        DEVICE FOR DETERMINING RELATIVE MOVEMENTS OR RELATIVE POSITIONS        OF TWO OBJECTS, published Oct. 31, 2007;    -   U.S. Patent Application Publication No. 2008/0001919, titled        USER INTERFACE DEVICE, published Jan. 3, 2008; and    -   U.S. Pat. No. 7,516,675, titled JOYSTICK SENSOR APPARATUS,        issued Apr. 14, 2009.

Referring again to the input device 1000 in FIG. 6, a joystick 1008extends from the central portion 1002. Forces exerted on the centralportion 1002 via the joystick 1008 define input motions for the sensorarrangement 1048. For example, the sensor arrangement 1048 in the base1004 can be configured to detect the input forces and moments applied bya surgeon to the joystick 1008. The joystick 1008 can be spring-biasedtoward a central, or home, position, in which the joystick 1008 isaligned with the Z axis, a vertical axis through the joystick 1008,central portion 1002, and the space joint 1006. Driving (e.g. pushingand/or pulling) the joystick 1008 away from the Z axis in any directioncan be configured to “drive” an end effector of an associated surgicaltool in the corresponding direction. When the external driving force isremoved, the joystick 1008 can be configured to return to the central,or home, position and motion of the end effector can be halted. Forexample, the central portion 1002 and joystick 1008 can be spring-biasedtoward the home position.

In various instances, the space joint 1006 and the joystick 1008 coupledthereto define a six degree-of-freedom input control. Referring againnow to the end effector 1052 of the surgical tool 1050 in FIG. 7, theforces on the joystick 1008 of the input device 1000 in the X directioncorrespond to displacement of the end effector 1052 along the X_(t) axisthereof (e.g. longitudinally), forces on the joystick 1008 in the Ydirection correspond to displacement of the end effector 1052 along theY_(t) axis thereof (e.g. laterally), and forces on the joystick 1008 inthe Z direction correspond to displacement of the end effector 1052along the Z_(t) axis (e.g. vertically/up and down). Additionally, forceson the joystick 1008 about the X axis (the moment forces R) result inrotation of the end effector 1052 about the X_(t) axis (e.g. a rollingmotion about a longitudinal axis in the direction R_(t)), forces on thejoystick 1008 about the Y axis (the moments forces P) result inarticulation of the end effector 1052 about the Y_(t) axis (e.g. apitching motion in the direction P_(t)), and forces on the joystick 1008about the Z axis (the moment forces T) result in articulation of the endeffector 1052 about the Z_(t) axis of the end effector (e.g. a yawing ortwisting motion in the direction T_(t)). In such instances, the inputdevice 1000 comprises a six-degree of freedom joystick, which isconfigured to receive and detect six degrees-of-freedom—forces along theX, Y, and Z axes and moments about the X, Y, and Z axes. The forces cancorrespond to translational input and the moments can correspond torotational inputs for the end effector 1052 of the associated surgicaltool 1050. Six degree-of-freedom input devices are further describedherein. Additional degrees of freedom (e.g. for actuating the jaws of anend effector or rolling the end effector about a longitudinal axis) canbe provided by additional joints supported by the joystick 1008, asfurther described herein.

In various instances, the input control device 1000 includes a joint orwrist 1010 that is offset from the space joint 1006. The wrist 1010 isoffset from the space joint 1006 by a shaft, or lever, 1012 extendingalong the shaft axis S that is parallel to the axis X in theconfiguration shown in FIG. 6. For example, the joystick 1008 can extendupright vertically from the central portion 1002 and the base 1004, andthe joystick 1008 can support the shaft 1012.

As further described herein, the space joint 1006 can define the inputcontrol motions for multiple degrees of freedom. For example, the spacejoint 1006 can define the input control motions for translation of thesurgical tool in three-dimensional space and articulation of thesurgical tool about at least one axis. Rolling motions can also becontrolled by inputs to the space joint 1006, as further describedherein. Moreover, the wrist 1010 can define input control motions for atleast one degree of freedom. For example, the wrist 1010 can define theinput control motions for the rolling motion of the end effector.Moreover, the wrist 1010 can support an end effector actuator 1020,which is further described herein, to apply open and closing motions tothe end effector.

In certain instances, the rolling, yawing, and pitching motions of theinput control device 1000 are translatable motions that definecorresponding input control motions for the related end effector. Invarious instances, the input control device 1000 can utilize adjustablescaling and/or gains such that the motion of the end effector isscalable in relationship to the control motions delivered at the wrist1010.

In one aspect, the input control device 1000 includes a plurality ofmechanical joints, which can be elastically-coupled components, sliders,journaled shafts, hinges, and/or rotary bearings, for example. Themechanical joints include a first joint 1040 (at the space joint 1006)intermediate the base 1004 and the central portion 1002, which allowsrotation and tilting of the central portion 1002 relative to the base1004, and a second joint 1044, which allows rotation of the wrist 1010relative to the joystick 1008. In various instances, six degrees offreedom of a robotic end effector (e.g. three-dimensional translationand rotation about three different axes) can be controlled by userinputs at only these two joints 1040, 1044, for example. With respect tomotion at the first joint 1040, the central portion 1002 can beconfigured to float relative to the base 1004 at elastic couplings. Withrespect to the second joint 1044, the wrist 1010 can be rotatablycoupled to the shaft 1012, such that the wrist 1010 can rotate in thedirection R (FIG. 6) about the shaft axis S. Rotation of the wrist 1010relative to the shaft 1012 can correspond to a rolling motion of an endeffector about a central tool axis, such as the rolling of the endeffector 1052 about the X_(t) axis. Rotation of the wrist 1010 by thesurgeon to roll an end effector provides control of the rolling motionat the surgeon's fingertips and corresponds to a first-personperspective control of the end effector (i.e. from the surgeon'sperspective, being “positioned” at the jaws of the remotely-positionedend effector at the surgical site). As further described herein, suchplacement and perspective can be utilized to supply precision controlmotions to the input control device 1000 during portions of a surgicalprocedure (e.g. a precision motion mode).

The various rotary joints of the input control device can include asensor arrangement configured to detect the rotary input controlsapplied thereto. The wrist 1010 can include a rotary sensor, which canbe a rotary force/torque sensor and/or transducer, rotary strain gaugeand/or strain gauge on a spring, and/or an optical sensor to detectrotary displacement at the joint, for example.

In certain instances, the input control device 1000 can include one ormore additional joints and/or hinges for the application of rotationalinput motions corresponding to articulation of an end effector. Forexample, the input control device 1000 can include a hinge along theshaft 1012 and/or between the shaft 1012 and the joystick 1008. In oneinstance, hinged input motions at such a joint can be detected byanother sensor arrangement and converted to rotary input control motionsfor the end effector, such as a yawing or pitching articulation of theend effector. Such an arrangement requires one or more additional sensorarrangements and would increase the mechanical complexity of the inputcontrol device.

The input control device 1000 also includes at least one additionalactuator, such as the actuation buttons 1026, 1028, for example, whichcan provide additional controls at the surgeon's fingertips. Forexample, the actuation buttons 1026, 1028 are positioned on the joystick1008 of the input control device. The actuation buttons 1026, 1028 cancorrespond to buttons for activating the surgical tool, such as firingand/or retracting a knife, energizing one or more electrodes, and/oradjusting an energy modularity, for example. In other instances, theactuation buttons 1026, 1028 can provide inputs to an imaging system toadjust a view of the surgical tool, such as zooming in/out, panning,tracking, titling and/or rotating, for example.

In various aspects, the actuation buttons 1026 and 1028 are used toselect between different motion scaling modes of the surgical tool 1050.For example, the actuation buttons 1026 and 1028 can be assigned to agross motion mode and fine motion mode of the surgical tool 1050. Themotion scaling of the surgical tool 1050 can be selectably adjusted touser input forces received by the input control device 1000, forexample.

Additional details regarding the input control device 1000 and otherrobotic surgical system input control mechanisms can be found inAttorney Docket No. END9052USNP1/180620-1, titled INPUT CONTROLS FORROBOTIC SURGERY, which is herein incorporated by reference in itsentirety.

Surgical Visualization Systems

During a surgical procedure, the information available to the clinicianvia the “naked eye” and/or an imaging system may provide an incompleteview of the surgical site. For example, certain structures, such asstructures embedded or buried within an organ, can be at least partiallyconcealed or hidden from view. Additionally, certain dimensions and/orrelative distances can be difficult to ascertain with existing sensorsystems and/or difficult for the “naked eye” to perceive. Moreover,certain structures can move preoperatively (e.g. before a surgicalprocedure but after a preoperative scan) and/or intraoperatively. Insuch instances, the clinician can be unable to accurately determine thelocation of a critical structure intraoperatively.

When the position of a critical structure is uncertain and/or when theproximity between the critical structure and a surgical tool is unknown,a clinician's decision-making process can be inhibited. For example, aclinician may avoid certain areas in order to avoid inadvertentdissection of a critical structure; however, the avoided area may beunnecessarily large and/or at least partially misplaced. Due touncertainty and/or overly/excessive exercises in caution, the clinicianmay not access certain desired regions. For example, excess caution maycause a clinician to leave a portion of a tumor and/or other undesirabletissue in an effort to avoid a critical structure even if the criticalstructure is not in the particular area and/or would not be negativelyimpacted by the clinician working in that particular area. In certaininstances, surgical results can be improved with increased knowledgeand/or certainty, which can allow a surgeon to be more accurate and, incertain instances, less conservative/more aggressive with respect toparticular anatomical areas.

For example, a visualization system can include a first light emitterconfigured to emit a plurality of spectral waves, a second light emitterconfigured to emit a light pattern, and one or more receivers, orsensors, configured to detect visible light, molecular responses to thespectral waves (spectral imaging), and/or the light pattern. Thesurgical visualization system can also include an imaging system and acontrol circuit in signal communication with the receiver(s) and theimaging system. Based on output from the receiver(s), the controlcircuit can determine a geometric surface map, i.e. three-dimensionalsurface topography, of the visible surfaces at the surgical site and oneor more distances with respect to the surgical site. In certaininstances, the control circuit can determine one more distances to an atleast partially concealed structure. Moreover, the imaging system canconvey the geometric surface map and the one or more distances to aclinician. In such instances, an augmented view of the surgical siteprovided to the clinician can provide a representation of the concealedstructure within the relevant context of the surgical site. For example,the imaging system can virtually augment the concealed structure on thegeometric surface map of the concealing and/or obstructing tissuesimilar to a line drawn on the ground to indicate a utility line belowthe surface. Additionally or alternatively, the imaging system canconvey the proximity of one or more surgical tools to the visible andobstructing tissue and/or to the at least partially concealed structureand/or the depth of the concealed structure below the visible surface ofthe obstructing tissue. For example, the visualization system candetermine a distance with respect to the augmented line on the surfaceof the visible tissue and convey the distance to the imaging system.

In various aspects of the present disclosure, a surgical visualizationsystem is disclosed for intraoperative identification and avoidance ofcritical structures. Such a surgical visualization system can providevaluable information to a clinician during a surgical procedure. As aresult, the clinician can confidently maintain momentum throughout thesurgical procedure knowing that the surgical visualization system istracking a critical structure such as a ureter, specific nerves, and/orcritical blood vessels, for example, which may be approached duringdissection, for example. In one aspect, the surgical visualizationsystem can provide an indication to the clinician in sufficient time forthe clinician to pause and/or slow down the surgical procedure andevaluate the proximity to the critical structure to prevent inadvertentdamage thereto. The surgical visualization system can provide an ideal,optimized, and/or customizable amount of information to the clinician toallow the clinician to move confidently and/or quickly through tissuewhile avoiding inadvertent damage to healthy tissue and/or criticalstructure(s) and, thus, to minimize the risk of harm resulting from thesurgical procedure.

FIG. 8 is a schematic of a surgical visualization system 1500 accordingto at least one aspect of the present disclosure. The surgicalvisualization system 1500 can create a visual representation of acritical structure 1501 within an anatomical field. The surgicalvisualization system 1500 can be used for clinical analysis and/ormedical intervention, for example. In certain instances, the surgicalvisualization system 1500 can be used intraoperatively to providereal-time, or near real-time, information to the clinician regardingproximity data, dimensions, and/or distances during a surgicalprocedure. The surgical visualization system 1500 is configured forintraoperative identification of critical structure(s) and/or tofacilitate the avoidance of the critical structure(s) 1501 by a surgicaldevice. For example, by identifying the critical structure 1501, aclinician can avoid maneuvering a surgical device around the criticalstructure 1501 and/or a region in a predefined proximity of the criticalstructure 1501 during a surgical procedure. The clinician can avoiddissection of and/or near a vein, artery, nerve, and/or vessel, forexample, identified as the critical structure 1501, for example. Invarious instances, the critical structure 1501 can be determined on apatient-by-patient and/or a procedure-by-procedure basis.

The surgical visualization system 1500 incorporates tissueidentification and geometric surface mapping in combination with adistance sensor system 1504. In combination, these features of thesurgical visualization system 1500 can determine a position of acritical structure 1501 within the anatomical field and/or the proximityof a surgical device 1502 to the surface 1505 of the visible tissueand/or to the critical structure 1501. Moreover, the surgicalvisualization system 1500 includes an imaging system that includes animaging device 1520, such as a camera, for example, configured toprovide real-time views of the surgical site. In various instances, theimaging device 1520 is a spectral camera (e.g. a hyperspectral camera,multispectral camera, or selective spectral camera), which is configuredto detect reflected spectral waveforms and generate a spectral cube ofimages based on the molecular response to the different wavelengths.Views from the imaging device 1520 can be provided to a clinician and,in various aspects of the present disclosure, can be augmented withadditional information based on the tissue identification, landscapemapping, and the distance sensor system 1504. In such instances, thesurgical visualization system 1500 includes a plurality of subsystems—animaging subsystem, a surface mapping subsystem, a tissue identificationsubsystem, and/or a distance determining subsystem. These subsystems cancooperate to intraoperatively provide advanced data synthesis andintegrated information to the clinician(s).

The imaging device can include a camera or imaging sensor that isconfigured to detect visible light, spectral light waves (visible orinvisible), and a structured light pattern (visible or invisible), forexample. In various aspects of the present disclosure, the imagingsystem can include an imaging device such as an endoscope, for example.Additionally or alternatively, the imaging system can include an imagingdevice such as an arthroscope, angioscope, bronchoscope,choledochoscope, colonoscope, cytoscope, duodenoscope, enteroscope,esophagogastro-duodenoscope (gastroscope), laryngoscope,nasopharyngo-neproscope, sigmoidoscope, thoracoscope, ureteroscope, orexoscope, for example. In other instances, such as in open surgeryapplications, the imaging system may not include a scope.

In various aspects of the present disclosure, the tissue identificationsubsystem can be achieved with a spectral imaging system. The spectralimaging system can rely on hyperspectral imaging, multispectral imaging,or selective spectral imaging, for example. Hyperspectral imaging oftissue is further described in U.S. Pat. No. 9,274,047, titled METHODSAND APPARATUS FOR IMAGING OF OCCLUDED OBJECTS, issued Mar. 1, 2016,which is incorporated by reference herein in its entirety.

In various aspect of the present disclosure, the surface mappingsubsystem can be achieved with a light pattern system, as furtherdescribed herein. The use of a light pattern (or structured light) forsurface mapping is known. Known surface mapping techniques can beutilized in the surgical visualization systems described herein.

Structured light is the process of projecting a known pattern (often agrid or horizontal bars) on to a surface. U.S. Patent ApplicationPublication No. 2017/0055819, titled SET COMPRISING A SURGICALINSTRUMENT, published Mar. 2, 2017, and U.S. Patent ApplicationPublication No. 2017/0251900, titled DEPICTION SYSTEM, published Sep. 7,2017, disclose a surgical system comprising a light source and aprojector for projecting a light pattern. U.S. Patent ApplicationPublication No. 2017/0055819, titled SET COMPRISING A SURGICALINSTRUMENT, published Mar. 2, 2017, and U.S. Patent ApplicationPublication No. 2017/0251900, titled DEPICTION SYSTEM, published Sep. 7,2017, are incorporated by reference herein in their respectiveentireties.

In various aspects of the present disclosure, the distance determiningsystem can be incorporated into the surface mapping system. For example,structured light can be utilized to generate a three-dimensional virtualmodel of the visible surface and determine various distances withrespect to the visible surface. Additionally or alternatively, thedistance determining system can rely on time-of-flight measurements todetermine one or more distances to the identified tissue (or otherstructures) at the surgical site.

FIG. 9 is a schematic diagram of a control system 1533, which can beutilized with the surgical visualization system 1500. The control system1533 includes a control circuit 1532 in signal communication with amemory 1534. The memory 1534 stores instructions executable by thecontrol circuit 1532 to determine and/or recognize critical structures(e.g. the critical structure 1501 in FIG. 8), determine and/or computeone or more distances and/or three-dimensional digital representations,and to communicate certain information to one or more clinicians. Forexample, the memory 1534 stores surface mapping logic 1536, imaginglogic 1538, tissue identification logic 1540, or distance determininglogic 1541 or any combinations of the logic 1536, 1538, 1540, and 1541.The control system 1533 also includes an imaging system 1542 having oneor more cameras 1544 (like the imaging device 1520 in FIG. 8), one ormore displays 1546, or one or more controls 1548 or any combinations ofthese elements. The camera 1544 can include one or more image sensors1535 to receive signals from various light sources emitting light atvarious visible and invisible spectra (e.g. visible light, spectralimagers, three-dimensional lens, among others). The display 1546 caninclude one or more screens or monitors for depicting real, virtual,and/or virtually-augmented images and/or information to one or moreclinicians.

In various aspects, the heart of the camera 1544 is the image sensor1535. Generally, modern image sensors 1535 are solid-state electronicdevices containing up to millions of discrete photodetector sites calledpixels. The image sensor 1535 technology falls into one of twocategories: Charge-Coupled Device (CCD) and Complementary Metal OxideSemiconductor (CMOS) imagers and more recently, short-wave infrared(SWIR) is an emerging technology in imaging. Another type of imagesensor 1535 employs a hybrid CCD/CMOS architecture (sold under the name“sCMOS”) and consists of CMOS readout integrated circuits (ROICs) thatare bump bonded to a CCD imaging substrate. CCD and CMOS image sensors1535 are sensitive to wavelengths from approximately 350-1050 nm,although the range is usually given from 400-1000 nm. CMOS sensors are,in general, more sensitive to IR wavelengths than CCD sensors. Solidstate image sensors 1535 are based on the photoelectric effect and, as aresult, cannot distinguish between colors. Accordingly, there are twotypes of color CCD cameras: single chip and three-chip. Single chipcolor CCD cameras offer a common, low-cost imaging solution and use amosaic (e.g. Bayer) optical filter to separate incoming light into aseries of colors and employ an interpolation algorithm to resolve fullcolor images. Each color is, then, directed to a different set ofpixels. Three-chip color CCD cameras provide higher resolution byemploying a prism to direct each section of the incident spectrum to adifferent chip. More accurate color reproduction is possible, as eachpoint in space of the object has separate RGB intensity values, ratherthan using an algorithm to determine the color. Three-chip cameras offerextremely high resolutions.

The control system 1533 also includes a spectral light source 1550 and astructured light source 1552. In certain instances, a single source canbe pulsed to emit wavelengths of light in the spectral light source 1550range and wavelengths of light in the structured light source 1552range. Alternatively, a single light source can be pulsed to providelight in the invisible spectrum (e.g. infrared spectral light) andwavelengths of light on the visible spectrum. The spectral light source1550 can be a hyperspectral light source, a multispectral light source,and/or a selective spectral light source, for example. In variousinstances, the tissue identification logic 1540 can identify criticalstructure(s) via data from the spectral light source 1550 received bythe image sensor 1535 portion of the camera 1544. The surface mappinglogic 1536 can determine the surface contours of the visible tissuebased on reflected structured light. With time-of-flight measurements,the distance determining logic 1541 can determine one or moredistance(s) to the visible tissue and/or the critical structure 1501.One or more outputs from the surface mapping logic 1536, the tissueidentification logic 1540, and the distance determining logic 1541, canbe provided to the imaging logic 1538, and combined, blended, and/oroverlaid to be conveyed to a clinician via the display 1546 of theimaging system 1542.

Referring now to FIG. 9A, where a schematic of a control system 600 fora surgical visualization system, such as the surgical visualizationsystem 1500, for example, is depicted. The control system 600 is aconversion system that integrates spectral signature tissueidentification and structured light tissue positioning to identifycritical structures, especially when those structures are obscured byother tissue, such as fat, connective tissue, blood, and/or otherorgans, for example. Such technology could also be useful for detectingtissue variability, such as differentiating tumors and/or non-healthytissue from healthy tissue within an organ.

The control system 600 is configured for implementing a hyperspectralimaging and visualization system in which a molecular response isutilized to detect and identify anatomy in a surgical field of view. Thecontrol system 600 includes a conversion logic circuit 648 to converttissue data to surgeon usable information. For example, the variablereflectance based on wavelengths with respect to obscuring material canbe utilized to identify the critical structure in the anatomy. Moreover,the control system 600 combines the identified spectral signature andthe structural light data in an image. For example, the control system600 can be employed to create of three-dimensional data set for surgicaluse in a system with augmentation image overlays. Techniques can beemployed both intraoperatively and preoperatively using additionalvisual information. In various instances, the control system 600 isconfigured to provide warnings to a clinician when in the proximity ofone or more critical structures. Various algorithms can be employed toguide robotic automation and semi-automated approaches based on thesurgical procedure and proximity to the critical structure(s).

A projected array of lights is employed to determine tissue shape andmotion intraoperatively. Alternatively, flash Lidar may be utilized forsurface mapping of the tissue.

The control system 600 is configured to detect the critical structure(s)and provide an image overlay of the critical structure and measure thedistance to the surface of the visible tissue and the distance to theembedded/buried critical structure(s). In other instances, the controlsystem 600 can measure the distance to the surface of the visible tissueor detect the critical structure(s) and provide an image overlay of thecritical structure.

The control system 600 includes a spectral control circuit 602. Thespectral control circuit 602 can be a field programmable gate array(FPGA) or another suitable circuit configuration. The spectral controlcircuit 602 includes a processor 604 to receive video input signals froma video input processor 606. The processor 604 can be configured forhyperspectral processing and can utilize C/C++ code, for example. Thevideo input processor 606 receives video-in of control (metadata) datasuch as shutter time, wave length, and sensor analytics, for example.The processor 604 is configured to process the video input signal fromthe video input processor 606 and provide a video output signal to avideo output processor 608, which includes a hyperspectral video-out ofinterface control (metadata) data, for example. The video outputprocessor 608 provides the video output signal to an image overlaycontroller 610.

The video input processor 606 is coupled to a camera 612 at the patientside via a patient isolation circuit 614. As previously discussed, thecamera 612 includes a solid state image sensor 634. The patientisolation circuit can include a plurality of transformers so that thepatient is isolated from other circuits in the system. The camera 612receives intraoperative images through optics 632 and the image sensor634. The image sensor 634 can include a CMOS image sensor, for example.In one aspect, the camera 612 outputs images in 14 bit/pixel signals. Itwill be appreciated that higher or lower pixel resolutions may beemployed without departing from the scope of the present disclosure. Theisolated camera output signal 613 is provided to a color RGB fusioncircuit 616, which employs a hardware register 618 and a Nios2co-processor 620 to process the camera output signal 613. A color RGBfusion output signal is provided to the video input processor 606 and alaser pulsing control circuit 622.

The laser pulsing control circuit 622 controls a laser light engine 624.The laser light engine 624 outputs light in a plurality of wavelengths(λ₁, λ₂, λ₃ . . . λ_(n)) including near infrared (NIR). The laser lightengine 624 can operate in a plurality of modes. In one aspect, the laserlight engine 624 can operate in two modes, for example. In a first mode,e.g. a normal operating mode, the laser light engine 624 outputs anilluminating signal. In a second mode, e.g. an identification mode, thelaser light engine 624 outputs RGBG and NIR light. In various instances,the laser light engine 624 can operate in a polarizing mode.

Light output 626 from the laser light engine 624 illuminates targetedanatomy in an intraoperative surgical site 627. The laser pulsingcontrol circuit 622 also controls a laser pulse controller 628 for alaser pattern projector 630 that projects a laser light pattern 631,such as a grid or pattern of lines and/or dots, at a predeterminedwavelength (λ₂) on the operative tissue or organ at the surgical site627. The camera 612 receives the patterned light as well as thereflected light output through the camera optics 632. The image sensor634 converts the received light into a digital signal.

The color RGB fusion circuit 616 also outputs signals to the imageoverlay controller 610 and a video input module 636 for reading thelaser light pattern 631 projected onto the targeted anatomy at thesurgical site 627 by the laser pattern projector 630. A processingmodule 638 processes the laser light pattern 631 and outputs a firstvideo output signal 640 representative of the distance to the visibletissue at the surgical site 627. The data is provided to the imageoverlay controller 610. The processing module 638 also outputs a secondvideo signal 642 representative of a three-dimensional rendered shape ofthe tissue or organ of the targeted anatomy at the surgical site.

The first and second video output signals 640, 642 include datarepresentative of the position of the critical structure on athree-dimensional surface model, which is provided to an integrationmodule 643. In combination with data from the video out processor 608 ofthe spectral control circuit 602, the integration module 643 candetermine the distance d_(A) (FIG. 1) to a buried critical structure(e.g. via triangularization algorithms 644), and the distance d_(A) canbe provided to the image overlay controller 610 via a video outprocessor 646. The foregoing conversion logic can encompass theconversion logic circuit 648 intermediate video monitors 652 and thecamera 612, the laser light engine 624, and laser pattern projector 630positioned at the surgical site 627.

Preoperative data 650 from a CT or MRI scan can be employed to registeror align certain three-dimensional deformable tissue in variousinstances. Such preoperative data 650 can be provided to the integrationmodule 643 and ultimately to the image overlay controller 610 so thatsuch information can be overlaid with the views from the camera 612 andprovided to the video monitors 652.

The video monitors 652 can output the integrated/augmented views fromthe image overlay controller 610. A clinician can select and/or togglebetween different views on one or more monitors. On a first monitor 652a, the clinician can toggle between (A) a view in which athree-dimensional rendering of the visible tissue is depicted and (B) anaugmented view in which one or more hidden critical structures aredepicted over the three-dimensional rendering of the visible tissue. Ona second monitor 652 b, the clinician can toggle on distancemeasurements to one or more hidden critical structures and/or thesurface of visible tissue, for example.

The control system 600 and/or various control circuits thereof can beincorporated into various surgical visualization systems disclosedherein.

The description now turns briefly to FIGS. 10A-10C to describe variousaspects of the control circuits 1532, 600 for controlling variousaspects of the surgical visualization system 1500. Turning to FIG. 10A,there is illustrated a control circuit 1600 configured to controlaspects of the surgical visualization system 1500, according to at leastone aspect of this disclosure. The control circuit 1600 can beconfigured to implement various processes described herein. The controlcircuit 1600 may comprise a microcontroller comprising one or moreprocessors 1602 (e.g., microprocessor, microcontroller) coupled to atleast one memory circuit 1604. The memory circuit 1604 storesmachine-executable instructions that, when executed by the processor1602, cause the processor 1602 to execute machine instructions toimplement various processes described herein. The processor 1602 may beany one of a number of single-core or multicore processors known in theart. The memory circuit 1604 may comprise volatile and non-volatilestorage media. The processor 1602 may include an instruction processingunit 1606 and an arithmetic unit 1608. The instruction processing unitmay be configured to receive instructions from the memory circuit 1604of this disclosure.

FIG. 10B illustrates a combinational logic circuit 1610 configured tocontrol aspects of the surgical visualization system 1500, according toat least one aspect of this disclosure. The combinational logic circuit1610 can be configured to implement various processes described herein.The combinational logic circuit 1610 may comprise a finite state machinecomprising a combinational logic 1612 configured to receive dataassociated with the surgical instrument or tool at an input 1614,process the data by the combinational logic 1612, and provide an output1616.

FIG. 10C illustrates a sequential logic circuit 1620 configured tocontrol aspects of the surgical visualization system 1500, according toat least one aspect of this disclosure. The sequential logic circuit1620 or the combinational logic 1622 can be configured to implementvarious processes described herein. The sequential logic circuit 1620may comprise a finite state machine. The sequential logic circuit 1620may comprise a combinational logic 1622, at least one memory circuit1624, and a clock 1629, for example. The at least one memory circuit1624 can store a current state of the finite state machine. In certaininstances, the sequential logic circuit 1620 may be synchronous orasynchronous. The combinational logic 1622 is configured to receive dataassociated with a surgical device or system from an input 1626, processthe data by the combinational logic 1622, and provide an output 1628. Inother aspects, the circuit may comprise a combination of a processor(e.g., processor 1602 in FIG. 10A) and a finite state machine toimplement various processes herein. In other aspects, the finite statemachine may comprise a combination of a combinational logic circuit(e.g., combinational logic circuit 1610, FIG. 10B) and the sequentiallogic circuit 1620.

Referring again to the surgical visualization system 1500 in FIG. 8, thecritical structure 1501 can be an anatomical structure of interest. Forexample, the critical structure 1501 can be a ureter, an artery such asa superior mesenteric artery, a vein such as a portal vein, a nerve suchas a phrenic nerve, and/or a tumor, among other anatomical structures.In other instances, the critical structure 1501 can be a foreignstructure in the anatomical field, such as a surgical device, surgicalfastener, clip, tack, bougie, band, and/or plate, for example. Examplecritical structures are further described in U.S. patent applicationSer. No. 16/128,192, titled VISUALIZATION OF SURGICAL DEVICES, filedSep. 11, 2018, which is hereby incorporated by reference herein in itsentirety.

In one aspect, a critical structure can be on the surface 1505 of thetissue 1503. In another aspect, the critical structure 1501 may beembedded in tissue 1503. Stated differently, the critical structure 1501may be positioned below the surface 1505 of the tissue 1503. In suchinstances, the tissue 1503 conceals the critical structure 1501 from theclinician's view. The critical structure 1501 is also obscured from theview of the imaging device 1520 by the tissue 1503. The tissue 1503 canbe fat, connective tissue, adhesions, and/or organs, for example. Inother instances, the critical structure 1501 can be partially obscuredfrom view.

FIG. 8 also depicts the surgical device 1502. The surgical device 1502includes an end effector having opposing jaws extending from the distalend of the shaft of the surgical device 1502. The surgical device 1502can be any suitable surgical device such as, for example, a dissector, astapler, a grasper, a clip applier, and/or an energy device includingmono-polar probes, bi-polar probes, ablation probes, and/or anultrasonic end effector. Additionally or alternatively, the surgicaldevice 1502 can include another imaging or diagnostic modality, such asan ultrasound device, for example. In one aspect of the presentdisclosure, the surgical visualization system 1500 can be configured toachieve identification of one or more critical structures 1501 and theproximity of the surgical device 1502 to the critical structure(s) 1501.

The imaging device 1520 of the surgical visualization system 1500 isconfigured to detect light at various wavelengths, such as, for example,visible light, spectral light waves (visible or invisible), and astructured light pattern (visible or invisible). The imaging device 1520may include a plurality of lenses, sensors, and/or receivers fordetecting the different signals. For example, the imaging device 1520can be a hyperspectral, multispectral, or selective spectral camera, asfurther described herein. The imaging device 1520 can also include awaveform sensor 1522 (such as a spectral image sensor, detector, and/orthree-dimensional camera lens). For example, the imaging device 1520 caninclude a right-side lens and a left-side lens used together to recordtwo two-dimensional images at the same time and, thus, generate athree-dimensional image of the surgical site, render a three-dimensionalimage of the surgical site, and/or determine one or more distances atthe surgical site. Additionally or alternatively, the imaging device1520 can be configured to receive images indicative of the topography ofthe visible tissue and the identification and position of hiddencritical structures, as further described herein. For example, the fieldof view of the imaging device 1520 can overlap with a pattern of light(structured light) on the surface 1505 of the tissue, as shown in FIG.8.

In one aspect, the surgical visualization system 1500 may beincorporated into a robotic system 1510. For example, the robotic system1510 may include a first robotic arm 1512 and a second robotic arm 1514.The robotic arms 1512, 1514 include rigid structural members 1516 andjoints 1518, which can include servomotor controls. The first roboticarm 1512 is configured to maneuver the surgical device 1502, and thesecond robotic arm 1514 is configured to maneuver the imaging device1520. A robotic control unit can be configured to issue control motionsto the robotic arms 1512, 1514, which can affect the surgical device1502 and the imaging device 1520, for example.

The surgical visualization system 1500 also includes an emitter 1506,which is configured to emit a pattern of light, such as stripes, gridlines, and/or dots, to enable the determination of the topography orlandscape of the surface 1505. For example, projected light arrays 1530can be used for three-dimensional scanning and registration on thesurface 1505. The projected light arrays 1530 can be emitted from theemitter 1506 located on the surgical device 1502 and/or one of therobotic arms 1512, 1514 and/or the imaging device 1520, for example. Inone aspect, the projected light array 1530 is employed to determine theshape defined by the surface 1505 of the tissue 1503 and/or the motionof the surface 1505 intraoperatively. The imaging device 1520 isconfigured to detect the projected light arrays 1530 reflected from thesurface 1505 to determine the topography of the surface 1505 and variousdistances with respect to the surface 1505.

In one aspect, the imaging device 1520 also may include an opticalwaveform emitter 1523 that is configured to emit an array 1529 ofelectromagnetic radiation 1524 (NIR photons) that can penetrate thesurface 1505 of the tissue 1503 and reach the critical structure 1501.The imaging device 1520 and the optical waveform emitter 1523 thereoncan be positionable by the robotic arm 1514. A corresponding waveformsensor 1522 (an image sensor, spectrometer, or vibrational sensor, forexample) on the imaging device 1520 is configured to detect the effectof the electromagnetic radiation received by the waveform sensor 1522.The wavelengths of the electromagnetic radiation 1524 emitted by theoptical waveform emitter 1523 can be configured to enable theidentification of the type of anatomical and/or physical structure, suchas the critical structure 1501. The identification of the criticalstructure 1501 can be accomplished through spectral analysis,photo-acoustics, and/or ultrasound, for example. In one aspect, thewavelengths of the electromagnetic radiation 1524 may be variable. Thewaveform sensor 1522 and optical waveform emitter 1523 may be inclusiveof a multispectral imaging system and/or a selective spectral imagingsystem, for example. In other instances, the waveform sensor 1522 andoptical waveform emitter 1523 may be inclusive of a photoacousticimaging system, for example. In other instances, the optical waveformemitter 1523 can be positioned on a separate surgical device from theimaging device 1520.

The surgical visualization system 1500 also may include the distancesensor system 1504 configured to determine one or more distances at thesurgical site. In one aspect, the time-of-flight distance sensor system1504 may be a time-of-flight distance sensor system that includes anemitter, such as the emitter 1506, and a receiver 1508, which can bepositioned on the surgical device 1502. In other instances, thetime-of-flight emitter can be separate from the structured lightemitter. In one general aspect, the emitter 1506 portion of thetime-of-flight distance sensor system 1504 may include a very tiny lasersource and the receiver 1508 portion of the time-of-flight distancesensor system 1504 may include a matching sensor. The time-of-flightdistance sensor system 1504 can detect the “time of flight,” or how longthe laser light emitted by the emitter 1506 has taken to bounce back tothe sensor portion of the receiver 1508. Use of a very narrow lightsource in the emitter 1506 enables the distance sensor system 1504 todetermining the distance to the surface 1505 of the tissue 1503 directlyin front of the distance sensor system 1504. Referring still to FIG. 8,d_(e) is the emitter-to-tissue distance from the emitter 1506 to thesurface 1505 of the tissue 1503 and d_(t) is the device-to-tissuedistance from the distal end of the surgical device 1502 to the surface1505 of the tissue. The distance sensor system 1504 can be employed todetermine the emitter-to-tissue distance d_(e). The device-to-tissuedistance d_(t) is obtainable from the known position of the emitter 1506on the shaft of the surgical device 1502 relative to the distal end ofthe surgical device 1502. In other words, when the distance between theemitter 1506 and the distal end of the surgical device 1502 is known,the device-to-tissue distance d_(t) can be determined from theemitter-to-tissue distance d_(e). In certain instances, the shaft of thesurgical device 1502 can include one or more articulation joints, andcan be articulatable with respect to the emitter 1506 and the jaws. Thearticulation configuration can include a multi-joint vertebrae-likestructure, for example. In certain instances, a three-dimensional cameracan be utilized to triangulate one or more distances to the surface1505.

In various instances, the receiver 1508 for the time-of-flight distancesensor system 1504 can be mounted on a separate surgical device insteadof the surgical device 1502. For example, the receiver 1508 can bemounted on a cannula or trocar through which the surgical device 1502extends to reach the surgical site. In still other instances, thereceiver 1508 for the time-of-flight distance sensor system 1504 can bemounted on a separate robotically-controlled arm (e.g. the robotic arm1514), on a movable arm that is operated by another robot, and/or to anoperating room (OR) table or fixture. In certain instances, the imagingdevice 1520 includes the time-of-flight receiver 1508 to determine thedistance from the emitter 1506 to the surface 1505 of the tissue 1503using a line between the emitter 1506 on the surgical device 1502 andthe imaging device 1520. For example, the distance d_(e) can betriangulated based on known positions of the emitter 1506 (on thesurgical device 1502) and the receiver 1508 (on the imaging device 1520)of the time-of-flight distance sensor system 1504. The three-dimensionalposition of the receiver 1508 can be known and/or registered to therobot coordinate plane intraoperatively.

In certain instances, the position of the emitter 1506 of thetime-of-flight distance sensor system 1504 can be controlled by thefirst robotic arm 1512 and the position of the receiver 1508 of thetime-of-flight distance sensor system 1504 can be controlled by thesecond robotic arm 1514. In other instances, the surgical visualizationsystem 1500 can be utilized apart from a robotic system. In suchinstances, the distance sensor system 1504 can be independent of therobotic system.

In certain instances, one or more of the robotic arms 1512, 1514 may beseparate from a main robotic system used in the surgical procedure. Atleast one of the robotic arms 1512, 1514 can be positioned andregistered to a particular coordinate system without a servomotorcontrol. For example, a closed-loop control system and/or a plurality ofsensors for the robotic arms 1512, 1514 can control and/or register theposition of the robotic arm(s) 1512, 1514 relative to the particularcoordinate system. Similarly, the position of the surgical device 1502and the imaging device 1520 can be registered relative to a particularcoordinate system.

Referring still to FIG. 8, d_(w) is the camera-to-critical structuredistance from the optical waveform emitter 1523 located on the imagingdevice 1520 to the surface of the critical structure 1501, and d_(A) isthe depth of the critical structure 1501 below the surface 1505 of thetissue 1503 (i.e., the distance between the portion of the surface 1505closest to the surgical device 1502 and the critical structure 1501). Invarious aspects, the time-of-flight of the optical waveforms emittedfrom the optical waveform emitter 1523 located on the imaging device1520 can be configured to determine the camera-to-critical structuredistance d_(w). The use of spectral imaging in combination withtime-of-flight sensors is further described herein. Moreover, referringnow to FIG. 11, in various aspects of the present disclosure, the depthd_(A) of the critical structure 1501 relative to the surface 1505 of thetissue 1503 can be determined by triangulating from the distance d_(w)and known positions of the emitter 1506 on the surgical device 1502 andthe optical waveform emitter 1523 on the imaging device 1520 (and, thus,the known distance d_(x) therebetween) to determine the distance d_(y),which is the sum of the distances d_(e) and d_(A).

Additionally or alternatively, time-of-flight from the optical waveformemitter 1523 can be configured to determine the distance from theoptical waveform emitter 1523 to the surface 1505 of the tissue 1503.For example, a first waveform (or range of waveforms) can be utilized todetermine the camera-to-critical structure distance d_(w) and a secondwaveform (or range of waveforms) can be utilized to determine thedistance to the surface 1505 of the tissue 1503. In such instances, thedifferent waveforms can be utilized to determine the depth of thecritical structure 1501 below the surface 1505 of the tissue 1503.

Additionally or alternatively, in certain instances, the distance d_(A)can be determined from an ultrasound, a registered magnetic resonanceimaging (MRI) or computerized tomography (CT) scan. In still otherinstances, the distance d_(A) can be determined with spectral imagingbecause the detection signal received by the imaging device can varybased on the type of material. For example, fat can decrease thedetection signal in a first way, or a first amount, and collagen candecrease the detection signal in a different, second way, or a secondamount.

Referring now to a surgical visualization system 1560 in FIG. 12, inwhich a surgical device 1562 includes the optical waveform emitter 1523and the waveform sensor 1522 that is configured to detect the reflectedwaveforms. The optical waveform emitter 1523 can be configured to emitwaveforms for determining the distances d_(t) and d_(w) from a commondevice, such as the surgical device 1562, as further described herein.In such instances, the distance d_(A) from the surface 1505 of thetissue 1503 to the surface of the critical structure 1501 can bedetermined as follows:

d _(A) =d _(w) −d _(t).

As disclosed herein, various information regarding visible tissue,embedded critical structures, and surgical devices can be determined byutilizing a combination approach that incorporates one or moretime-of-flight distance sensors, spectral imaging, and/or structuredlight arrays in combination with an image sensor configured to detectthe spectral wavelengths and the structured light arrays. Moreover, theimage sensor can be configured to receive visible light and, thus,provide images of the surgical site to an imaging system. Logic oralgorithms are employed to discern the information received from thetime-of-flight sensors, spectral wavelengths, structured light, andvisible light and render three-dimensional images of the surface tissueand underlying anatomical structures. In various instances, the imagingdevice 1520 can include multiple image sensors.

FIG. 13 depicts a surgical visualization system 1700, which is similarto the surgical visualization system 1500 in many respects. In variousinstances, the surgical visualization system 1700 can be a furtherexemplification of the surgical visualization system 1500. Similar tothe surgical visualization system 1500, the surgical visualizationsystem 1700 includes a surgical device 1702 and an imaging device 1720.The imaging device 1720 includes a spectral light emitter 1723, which isconfigured to emit spectral light in a plurality of wavelengths toobtain a spectral image of hidden structures, for example. The imagingdevice 1720 can also include a three-dimensional camera and associatedelectronic processing circuits in various instances. The surgicalvisualization system 1700 is shown being utilized intraoperatively toidentify and facilitate avoidance of certain critical structures, suchas a ureter 1701 a and vessels 1701 b in an organ 1703 (the uterus inthis example), that are not visible on the surface.

The surgical visualization system 1700 is configured to determine anemitter-to-tissue distance d_(e) from an emitter 1706 on the surgicaldevice 1702 to a surface 1705 of the uterus 1703 via structured light.The surgical visualization system 1700 is configured to extrapolate adevice-to-tissue distance d_(t) from the surgical device 1702 to thesurface 1705 of the uterus 1703 based on the emitter-to-tissue distanced_(e). The surgical visualization system 1700 is also configured todetermine a tissue-to-ureter distance d_(A) from the ureter 1701 a tothe surface 1705 and a camera-to ureter distance d_(w) from the imagingdevice 1720 to the ureter 1701 a. As described herein with respect toFIG. 8, for example, the surgical visualization system 1700 candetermine the distance d_(w) with spectral imaging and time-of-flightsensors, for example. In various instances, the surgical visualizationsystem 1700 can determine (e.g. triangulate) the tissue-to-ureterdistance d_(A) (or depth) based on other distances and/or the surfacemapping logic described herein.

In still other aspects, the surgical visualization systems 1500, 1700can determine the distance or relative position of critical structuresutilizing fluoroscopy visualization techniques (e.g., utilizing a pairof cameras to triangulate the position of a structure or the contentsthereof treated with a fluorescent agent) or employing ditheringcameras, as are disclosed in U.S. patent application Ser. No.16/128,180, titled CONTROLLING AN EMITTER ASSEMBLY PULSE SEQUENCE, filedSep. 11, 2018, which is hereby incorporated by reference herein in itsentirety. In one aspect, a fluoroscopy visualization technology, such asfluorescent Indocyanine green (ICG), for example, can be utilized toilluminate a critical structure 3201, as shown in FIGS. 13F-13I. Acamera 3220 can include two optical waveforms sensors 3222, 3224, whichtake simultaneous left-side and right-side images of the criticalstructure 3201 (FIGS. 13G and 13H). In such instances, the camera 3220can depict a glow of the critical structure 3201 below the surface 3205of the tissue 3203, and the distance d_(w) can be determined by theknown distance between the sensors 3222 and 3224. In certain instances,distances can be determined more accurately by utilizing more than onecamera or by moving a camera between multiple locations. In certainaspects, one camera can be controlled by a first robotic arm and asecond camera by another robotic arm. In such a robotic system, onecamera can be a follower camera on a follower arm, for example. Thefollower arm, and camera thereon, can be programmed to track the othercamera and to maintain a particular distance and/or lens angle, forexample.

In still other aspects, the surgical visualization system 1500 mayemploy two separate waveform receivers (i.e. cameras/image sensors) todetermine d_(w). Referring now to FIG. 13J, if a critical structure 3301or the contents thereof (e.g. a vessel or the contents of the vessel)can emit a signal 3302, such as with fluoroscopy, then the actuallocation can be triangulated from two separate cameras 3320 a, 3320 b atknown locations.

FIG. 13K illustrates a structured (or patterned) light system 700,according to at least one aspect of the present disclosure. As describedherein, structured light in the form of stripes or lines, for example,can be projected from a light source and/or projector 706 onto thesurface 705 of targeted anatomy to identify the shape and contours ofthe surface 705. A camera 720, which can be similar in various respectsto the imaging device 520 (FIG. 24), for example, can be configured todetect the projected pattern of light on the surface 705. The way thatthe projected pattern deforms upon striking the surface 705 allowsvision systems to calculate the depth and surface information of thetargeted anatomy.

In certain instances, invisible (or imperceptible) structured light canbe utilized, in which case the structured light is used withoutinterfering with other computer vision tasks for which the projectedpattern may be confusing. For example, infrared light or extremely fastframe rates of visible light that alternate between two exact oppositepatterns can be utilized to prevent interference. Structured light isfurther described at en.wikipedia.org/wiki/Structured light.

In various instances, hyperspectral imaging technology, can be employedto identify signatures in anatomical structures in order todifferentiate a critical structure from obscurants. Hyperspectralimaging technology may provide a visualization system that can provide away to identify critical structures such as ureters and/or bloodvessels, for example, especially when those structures are obscured byfat, connective tissue, blood, or other organs, for example. The use ofthe difference in reflectance of different wavelengths in the infrared(IR) spectrum may be employed to determine the presence of keystructures versus obscurants. Referring now to FIGS. 13L-13N,illustrative hyperspectral signatures for a ureter, an artery, and nervetissue with respect to obscurants such as fat, lung tissue, and blood,for example, are depicted.

FIG. 13L is a graphical representation 950 of an illustrative uretersignature versus obscurants. The plots represent reflectance as afunction of wavelength (nm) for wavelengths for fat, lung tissue, blood,and a ureter. FIG. 13M is a graphical representation 952 of anillustrative artery signature versus obscurants. The plots representreflectance as a function of wavelength (nm) for fat, lung tissue,blood, and a vessel. FIG. 13N is a graphical representation 954 of anillustrative nerve signature versus obscurants. The plots representreflectance as a function of wavelength (nm) for fat, lung tissue,blood, and a nerve.

In another aspect, a surgical visualization system 1500 may employ adithering or moving camera 440 to determine the distance d_(w). Thecamera 440 is robotically-controlled such that the three-dimensionalcoordinates of the camera 440 at the different positions are known. Invarious instances, the camera 440 can pivot at a cannula or patientinterface. For example, if a critical structure 401 or the contentsthereof (e.g. a vessel or the contents of the vessel) can emit a signal,such as with fluoroscopy, for example, then the actual location can betriangulated from the camera 440 moved rapidly between two or more knownlocations. In FIG. 13A, the camera 440 is moved axially along an axis A.More specifically, the camera 440 translates a distance d₁ closer to thecritical structure 401 along the axis A to the location indicated as alocation 440′, such as by moving in and out on a robotic arm. As thecamera 440 moves the distance d₁ and the size of view change withrespect to the critical structure 401, the distance to the criticalstructure 401 can be calculated. For example, a 4.28 mm axialtranslation (the distance d₁) can correspond to an angle θ₁ of 6.28degrees and an angle θ₂ of 8.19 degrees. Additionally or alternatively,the camera 440 can rotate or sweep along an arc between differentpositions. Referring now to FIG. 13B, the camera 440 is moved axiallyalong the axis A and is rotated an angle θ₃ about the axis A. A pivotpoint 442 for rotation of the camera 440 is positioned at thecannula/patient interface. In FIG. 13B, the camera 440 is translated androtated to a location 440″. As the camera 440 moves and the edge of viewchanges with respect to the critical structure 401, the distance to thecritical structure 401 can be calculated. In FIG. 13B, a distance d₂ canbe 9.01 mm, for example, and the angle θ₃ can be 0.9 degrees, forexample.

Spectral imaging can be utilized intraoperatively to measure thedistance between a waveform emitter and a critical structure that isobscured by tissue. In one aspect of the present disclosure, referringnow to FIGS. 13C and 13D, a time-of-flight sensor system 1104 utilizingwaveforms 1124, 1125 is shown. The time-of-flight sensor system 1104 canbe incorporated into the surgical visualization system 1500 (FIG. 8) incertain instances. The time-of-flight sensor system 1104 includes awaveform emitter 1106 and a waveform receiver 1108 on the same surgicaldevice 1102. The emitted wave 1124 extends to the critical structure1101 from the emitter 1106 and the received wave 1125 is reflected backto the receiver 1108 from the critical structure 1101. The surgicaldevice 1102 is positioned through a trocar 1110 that extends into acavity 1107 in a patient.

The waveforms 1124, 1125 are configured to penetrate obscuring tissue1103. For example, the wavelengths of the waveforms 1124, 1125 can be inthe NIR or SWIR spectrum of wavelengths. In one aspect, a spectralsignal (e.g. hyperspectral, multispectral, or selective spectral) or aphotoacoustic signal can be emitted from the emitter 1106 and canpenetrate the tissue 1103 in which the critical structure 1101 isconcealed. The emitted waveform 1124 can be reflected by the criticalstructure 1101. The received waveform 1125 can be delayed due to thedistance d between the distal end of the surgical device 1102 and thecritical structure 1101. In various instances, the waveforms 1124, 1125can be selected to target the critical structure 1101 within the tissue1103 based on the spectral signature of the critical structure 1101, asfurther described herein. In various instances, the emitter 1106 isconfigured to provide a binary signal on and off, as shown in FIG. 13D,for example, which can be measured by the receiver 1108.

Based on the delay between the emitted wave 1124 and the received wave1125, the time-of-flight sensor system 1104 is configured to determinethe distance d (FIG. 13C). A time-of-flight timing diagram 1130 for theemitter 1106 and the receiver 1108 of FIG. 13C is shown in FIG. 13D. Thedelay is a function of the distance d and the distance d is given by:

$d = {\frac{ct}{2} \cdot \frac{q_{2}}{q_{1} + q_{2}}}$

where:

c=the speed of light;

t=length of pulse;

q₁=accumulated charge while light is emitted; and

q₂=accumulated charge while light is not being emitted.

As provided herein, the time-of-flight of the waveforms 1124, 1125corresponds to the distance din FIG. 13C. In various instances,additional emitters/receivers and/or pulsing signals from the emitter1106 can be configured to emit a non-penetrating signal. Thenon-penetrating tissue can be configured to determine the distance fromthe emitter to the surface 1105 of the obscuring tissue 1103. In variousinstances, the depth of the critical structure 1101 can be determinedby:

d _(A) =d _(w) −d _(t).

where:

d_(A)=the depth of the critical structure 1101 below the surface 1105 ofthe obscuring tissue 1103;

d_(w)=the distance from the emitter 1106 to the critical structure 1101(d in FIG. 13C); and

d_(t),=the distance from the emitter 1106 (on the distal end of thesurgical device 1102) to the surface 1105 of the obscuring tissue 1103.

In one aspect of the present disclosure, referring now to FIG. 13E, atime-of-flight sensor system 1204 utilizing waves 1224 a, 1224 b, 1224c, 1225 a, 1225 b, 1225 c is shown. The time-of-flight sensor system1204 can be incorporated into the surgical visualization system 1500(FIG. 8) in certain instances. The time-of-flight sensor system 1204includes a waveform emitter 1206 and a waveform receiver 1208. Thewaveform emitter 1206 is positioned on a first surgical device 1202 a,and the waveform receiver 1208 is positioned on a second surgical device1202 b. The surgical devices 1202 a, 1202 b are positioned through theirrespective trocars 1210 a, 1210 b, respectively, which extend into acavity 1207 in a patient. The emitted waves 1224 a, 1224 b, 1224 cextend toward a surgical site from the emitter 1206 and the receivedwaves 1225 a, 1225 b, 1225 c are reflected back to the receiver 1208from various structures and/or surfaces at the surgical site.

The different emitted waves 1224 a, 1224 b, 1224 c are configured totarget different types of material at the surgical site. For example,the wave 1224 a targets the obscuring tissue 1203, the wave 1224 btargets a first critical structure 1201 a (e.g. a vessel), and the wave1224 c targets a second critical structure 1201 b (e.g. a canceroustumor). The wavelengths of the waves 1224 a, 1224 b, 1224 c can be inthe visible light, NIR, or SWIR spectrum of wavelengths. For example,visible light can be reflected off a surface 1205 of the tissue 1203 andNIR and/or SWIR waveforms can be configured to penetrate the surface1205 of the tissue 1203. In various aspects, as described herein, aspectral signal (e.g. hyperspectral, multispectral, or selectivespectral) or a photoacoustic signal can be emitted from the emitter1206. In various instances, the waves 1224 b, 1224 c can be selected totarget the critical structures 1201 a, 1201 b within the tissue 1203based on the spectral signature of the critical structure 1201 a, 1201b, as further described herein. Photoacoustic imaging is furtherdescribed herein and in the aforementioned contemporaneously-filed U.S.Patent Applications, which are incorporated by reference herein in theirrespective entireties.

The emitted waves 1224 a, 1224 b, 1224 c can be reflected off thetargeted material (i.e. the surface 1205, the first critical structure1201 a, and the second structure 1201 b, respectively). The receivedwaveforms 1225 a, 1225 b, 1225 c can be delayed due to the distancesd_(1a), d_(2a), d_(3a), d_(1b), d_(2b), d_(3b) indicated in FIG. 13E.

In the time-of-flight sensor system 1204, in which the emitter 1206 andthe receiver 1208 are independently positionable (e.g., on separatesurgical devices 1202 a, 1202 b and/or controlled by separate roboticarms), the various distances d_(1a), d_(2a), d_(3a), d_(1b), d_(2b),d_(3b) can be calculated from the known position of the emitter 1206 andthe receiver 1208. For example, the positions can be known when thesurgical devices 1202 a, 1202 b are robotically-controlled. Knowledge ofthe positions of the emitter 1206 and the receiver 1208, as well as thetime of the photon stream to target a certain tissue and the informationreceived by the receiver 1208 of that particular response can allow adetermination of the distances d_(1a), d_(2a), d_(3a), d_(1b), d_(2b),d_(3b). In one aspect, the distance to the obscured critical structures1201 a, 1201 b can be triangulated using penetrating wavelengths.Because the speed of light is constant for any wavelength of visible orinvisible light, the time-of-flight sensor system 1204 can determine thevarious distances.

Referring still to FIG. 13E, in various instances, in the view providedto the clinician, the receiver 1208 can be rotated such that the centerof mass of the target structure in the resulting images remainsconstant, i.e., in a plane perpendicular to the axis of a select targetstructures 1203, 1201 a, or 1201 b. Such an orientation can quicklycommunicate one or more relevant distances and/or perspectives withrespect to the critical structure. For example, as shown in FIG. 13E,the surgical site is displayed from a viewpoint in which the criticalstructure 1201 a is perpendicular to the viewing plane (i.e. the vesselis oriented in/out of the page). In various instances, such anorientation can be default setting; however, the view can be rotated orotherwise adjusted by a clinician. In certain instances, the cliniciancan toggle between different surfaces and/or target structures thatdefine the viewpoint of the surgical site provided by the imagingsystem.

In various instances, the receiver 1208 can be mounted on a trocar orcannula, such as the trocar 1210 b, for example, through which thesurgical device 1202 b is positioned. In other instances, the receiver1208 can be mounted on a separate robotic arm for which thethree-dimensional position is known. In various instances, the receiver1208 can be mounted on a movable arm that is separate from the robotthat controls the surgical device 1202 a or can be mounted to anoperating room (OR) table that is intraoperatively registerable to therobot coordinate plane. In such instances, the position of the emitter1206 and the receiver 1208 can be registerable to the same coordinateplane such that the distances can be triangulated from outputs from thetime-of-flight sensor system 1204.

Scaling Movement According to Tissue Proximity

Many surgical robotic control interfaces force the user to move theirarms within a control space having a set “working volume” to manipulatethe movement and position of the surgical tools 126, 1050 (FIGS. 1 and7) and/or imaging devices 128 (FIG. 1) of the robotic surgical system110, 150 (FIGS. 1, 3) within the operative space (i.e., the total volumewithin which a user may wish to move or position the surgical tools 1050and/or imaging devices 128 during a surgical procedure). Oftentimes, auser can reach the outer limits of their control space but not the outerlimits of their operative space. In other words, the control space for arobotic surgical system 110 may not be coextensive with the availableoperative space in which the user may wish to manipulate the surgicaltools 1050 during a surgical procedure. In such instances, the user mustclutch out of the robotic input control devices 136 (FIG. 2), move theirhands back to a “home position” closer to their bodies, clutch back intothe input control devices 136, and then continue the surgical procedure.However, forcing users to clutch in and out of the input control devices136 is time consuming and unintuitive, which can impact the efficiencyof the surgical procedure. When a surgical procedure is not timeefficient or movement efficient for the operator of the robotic surgicalsystem 110, the additional time and exertion required by the surgeon toperform the procedure can lead to fatigue, which can in turn impact thesuccess of the surgical procedure. Therefore, it can be desirable toscale the movement of the robotic surgical system 110 such that therange of movement of the surgical system 110 is scaled with respect tothe movement of the input control devices 136.

Further, surgical robotic interfaces that utilize set relationshipsbetween input received from the input control devices 136 and theresulting movement in the surgical system 110 fail to account for thefact that, in some circumstances, it is not desirable for the roboticsurgical system 110 to be equally sensitive to movement input. Forexample, when a surgical tool 1050 is in close proximity to a patient tobe treated by the surgical tool, inadvertent control inputs have muchlarger consequences than when the surgical tool 1050 is far from thepatient because in the former situation the surgical tool 1050 caninadvertently contact and cause harm to the patient. Therefore, it canbe desirable to adjust the movement of the robotic surgical system 110when a surgical tool 1050 or another component thereof is near thepatient. In other words, the scaling of the movement of a surgical toolis adjusted in accordance with its distance from the patient.Accordingly, a robotic surgical system 110 can be configured to tailorthe movement of its surgical tools 1050 in response to a user inputaccording to the distance between the surgical tool 1050 or a componentthereof, such as an end effector 1052 (FIG. 7), and the patient.

As used herein, the term “surgical tool” can refer to a grasper (asillustrated in FIG. 7), a surgical stapler, an ultrasonic surgicalinstrument, a monopolar or bipolar electrosurgical instrument, and soon. By causing the movement of the robotic surgical system 110 to be afunction of the proximity of the surgical tools 1050 to the patient, therobotic control interface's control space can be coextensive with theoperative space of the robotic surgical system 110. For example, therelationship between the amount of movement in the robotic surgicalsystem 110 and the input received from the input control devices 136 canbe inconstant such that the robotic surgical system 110 translatessurgical tools 1050 through the operative space more quickly when thesurgical tools 1050 are farther from the patient and more slowly whenthe surgical tools 1050 are closer to the patient based on the sameinput received from the input control devices 136 (e.g., the amount offorce being exerted on the input control devices 136 by the surgeon).Because the movement of the robotic surgical system 110 is adjustablyrelated to the input from the input control devices 136, the controlspace can be scaled to the operative space of the robotic surgicalsystem 110. In particular, the robotic surgical system 110 can beconfigured to scale its movement such that it translates the surgicaltools 1050 more quickly when the surgical tools 1050 are far from thepatient and then automatically scales its movement as the surgical tools1050 approach the patient to avoid risking contact with the patient.Further, decreasing the rate at which the robotic surgical system 110moves the surgical tools 1050 when the surgical tools 1050 are in closeproximity to the patient has the additional benefit of reducing theamount of movement caused by inadvertent control inputs to the roboticsurgical system 110, which can prevent damage to the patient caused byinadvertent contact between the robotic surgical system components andthe patient.

Various aspects of the present disclosure discuss movement of a roboticsurgical system component such as a surgical tool 1050, which mayinclude an end effector 1052 (FIG. 7) or another component of therobotic surgical system near a patient. Various aspects of the presentdisclosure also discuss a distance d_(t) between the robotic surgicalsystem component and the patient. For the purpose of these discussions,the term patient comprises any tissue of the patient from which adistance to the surgical tool is determined. In at least one example,the tissue of the patient is a tissue along the path of the surgicaltool. In at least one example, the tissue of the patient is a tissuethat is ultimately contacted and/or treated by the surgical tool. In atleast one example, the tissue of the patient is a tissue within thepatient such as, for example, a tissue within a patient cavity. In atleast one example, the tissue of the patient is any critical tissue, asdescribed herein. In certain examples, the term patient encompasses anobject such as, for example, a tag or another surgical tool or componentof the robotic surgical system that is positioned near, on, or withinthe patient.

Various processes can be implemented to modify the movement of therobotic surgical system as a function of the distance between acomponent (e.g., an end effector) of the robotic surgical system and thepatient. For example, FIGS. 14 and 15 are logic flow diagrams ofprocesses 2000, 2050 for controlling the movement of a robotic surgicalsystem, in accordance with at least one aspect of the presentdisclosure. The processes 2000, 2050 can be executed by a controlcircuit of a computer system, such as the processor 158 of the roboticsurgical system 150 illustrated in FIG. 3 or the control circuit 1532 ofthe control system 1533 illustrated in FIG. 9. Accordingly, theprocesses 2000, 2050 can be embodied as a set of computer-executableinstructions stored in a memory 1534 (FIG. 9) that, when executed by thecontrol circuit 1532, cause the computer system (e.g., the controlsystem 1533) to perform the described steps. Further, although theprocesses 2000, 2050 depicted in FIGS. 14 and 15 are described as beingexecuted by a control circuit 1532 of a control system 1533, this ismerely for brevity, and it should be understood that the depictedprocesses 2000, 2050 can be executed by circuitry that can include avariety of hardware and/or software components and may be located in orassociated with various systems integral or connected to a roboticsurgical system 150.

In some aspects, the control circuit 1532 can scale the movement of therobotic surgical system according to whether the measured distancebetween the robotic surgical system and/or a component thereof meets orexceeds one or more thresholds. For example, FIG. 14 illustrates aprocess 2000 for scaling the motion of the robotic surgical system basedon the distance between the robotic surgical system and/or a componentthereof relative to one threshold. The control circuit 1532 can becoupled to a motor of the robotic surgical system 150 that may cause acomponent of the robotic surgical system 150 such as, for example, asurgical tool 1050 to move in response to an instrument motion controlsignal received 2002 through the input control device 1000. In oneaspect, the input control device 1000 and/or robotic surgical system 150can be operable in gross or fine (i.e., precision) motion control modes,as described above under the heading INPUT CONTROL DEVICES.

Accordingly, a control circuit 1532 executing the process 2000determines 2004 the distance d_(t) between a component of the roboticsurgical system 150, such as a surgical tool 1050 or an end effector1052 thereof, and the tissue of the patient. The control circuit 1532can measure the distance d_(t) utilizing TOF, structured light, andother such techniques via the visualization system 1500 (FIG. 8)described above under the heading SURGICAL VISUALIZATION SYSTEMS, forexample. In one aspect, the control circuit 1532 can receive thedistance d_(t) from a distance sensor system 1504 (FIG. 8), which caninclude a TOF sensor or other such distance sensors, as described above.

Accordingly, the control circuit 1532 compares 2006 the distance d_(t)to a threshold distance to determine whether the robotic surgical systemcomponent is within the threshold distance to the patient. The controlcircuit 1532 can, for example, retrieve the threshold distance from amemory. In one aspect, the control circuit 1532 determines whether thedistance d_(t) is greater than or equal to the threshold distance.

If the distance d_(t) is greater than or equal to the threshold distance(i.e., the robotic surgical system component is farther away from thepatient than the threshold distance), then the process 2000 proceedsalong the YES branch and the control circuit 1532 scales 2008 the amountof movement of the robotic surgical system 150 caused by the grossmotion controls of the input control device 1000 according to thedistance d_(t). In one example, the control circuit 1532 activates agross motion mode, which can scale the sensitivity of the movementgenerated by the robotic surgical system 150 with respect to the userinput received via the input control device 1000. As another example,the control circuit 1532 can scale the control signal generated by theinput control device 1000 or scale the amount of force required to beexerted by the user on the input control device 1000 to cause therobotic system to move a set distance or speed.

If the distance d_(t) is not greater than or equal to the thresholddistance (i.e., the robotic surgical system component is at thethreshold distance from the patient or closer to the patient than thethreshold distance), then the process 2000 proceeds along the NO branchand the control circuit 1532 deactivates 2010 gross motion of therobotic surgical system or otherwise prevents the robotic surgicalsystem 150 from being operated in a gross motion mode. In one aspect,the control circuit 1532 changes an internal setting of the roboticsurgical system 150 from a gross motion mode to a fine-movement mode.Regardless of the evaluation of the distance d_(t), the control circuit1532 can continue to monitor the position of the robotic surgical systemcomponent and the patient and control the movement of the roboticsurgical system 150 accordingly throughout the course of the surgicalprocedure.

As another example, FIG. 15 illustrates a process 2050 for scaling themotion of the robotic surgical system 150 based on the distance betweenthe robotic surgical system 150 and/or a component thereof relative tomultiple thresholds. The control circuit 1532 can take a variety ofdifferent actions according to the distance d_(t) relative to particularthresholds.

Accordingly, as described above with respect to the process 2050illustrated in FIG. 15, the control circuit 1532 receives 2052 aninstrument motion control signal from, for example, a robotic inputcontrol device 1000 and determines 2054 the distance d_(t) between acomponent of the robotic surgical system and a tissue of the patient.

Accordingly, the control circuit 1532 compares 2056 the distance d_(t)to a first threshold distance D₁ to determine whether the roboticsurgical system component is within the threshold distance D₁ to thepatient. In one aspect, the control circuit 1532 determines whether thedistance d_(t) is greater than or equal to the threshold distance D₁. Ifthe distance d_(t) is greater than or equal to the threshold distance D₁(i.e., the robotic surgical system component is farther away from thepatient than the threshold distance D₁), then the process 2050 proceedsalong the YES branch and the control circuit 1532 causes the roboticsurgical system component to scale 2058 the movement of the roboticsurgical system 150 such as, for example, by activating the gross motionmode, as described above. In various aspects, the control circuit 1532can cause the robotic surgical system to operate at a default speed orcause the motion controls to operate at the default sensitivity in thegross motion mode, wherein the default speed and/or sensitivity arescaled in accordance with predetermined parameters of the gross motionmode. If the distance d_(t) is not greater than the threshold distanceD₁ (i.e., the robotic surgical system component is at the thresholddistance D₁ from the patient or closer to the patient than the thresholddistance D₁), then the process 2050 proceeds along the NO branch.

Accordingly, the control circuit 1532 compares 2060 the distance d_(t)to a second threshold distance D₂ to determine whether the roboticsurgical system component is within the threshold distance D₂ to thepatient. In one aspect, the control circuit 1532 determines whether thedistance d_(t) is greater than the threshold distance D₂. If thedistance d_(t) is greater than the threshold distance D₂, then theprocess 2050 proceeds along the YES branch and the control circuit 1532adjusts 2062 the scaling of the gross motion controls according to thedistance d_(t).

If the distance d_(t) is not greater than the threshold distance D₂,then the process 2050 proceeds along the NO branch and the controlcircuit 1532 deactivates 2064 gross motion of the robotic surgicalsystem, as described above. In one aspect, the control circuit 1532changes an internal setting of the robotic surgical system 150 from agross motion mode to a fine-movement mode. Regardless of the evaluationof the distance d_(t), the control circuit 1532 can continue to monitorthe position of the robotic surgical system component and the patientand control the movement of the robotic surgical system accordinglythroughout the course of the surgical procedure.

The values of the thresholds distances D₁ and/or D₂ can be stored in amemory of the control unit 1532 and can be accessed by a processorexecuting the process 2050 and/or the process 2000. Although theprocesses 2000 and 2050 use the inequality symbol “≥” in comparing thedistance d_(t) to threshold, this is not limiting. In alternativeembodiments, the processes 2000, 2050 may use the inequality symbol “>”instead of the inequality symbol “≥”. For example, in the process 2000,the scaling 2008 can be limited to situations where the distance d_(t)is greater than the threshold, and the deactivation 2010 of the scalingcan be triggered by any distance d_(t) that is less than or equal to thethreshold.

FIG. 16 is a graph 2100 of the relationship between input from the inputcontrol device 1000 and the movement of the robotic surgical system 150based on the proximity of the surgical tool 1050 to a tissue of apatient, according to a prophetic implementation of the process 2050. Inthe graph 2100, the vertical axis 2102 represents the user input forcerequired to be exerted on the input control device 1000 to move therobotic surgical system 150 a particular distance or at a particularspeed, the horizontal axis 2104 represents the distance d_(t), and theline 2106 represents the change in the user input force required to movethe robotic surgical system 150 according to the process 2050illustrated in FIG. 15.

In various examples, the input control device 1000 includes a sensorarrangement 1048 (FIG. 9), which may include one or more force sensorsfor assessing the user input force. In such examples, the sensorarrangement 1048 transmits an instrument motion control signal to thecontrol circuit 1532 commensurate with the user input force detected bythe sensor arrangement 1048.

Notably, aspects of the processes for controlling the movement of arobotic surgical system 150 discussed herein that incorporate or utilizemultiple thresholds can define various zones for particular parameters(e.g., the distance d_(t)) in which the control system 1533 controls therobotic surgical system differently. For example, the thresholds D₁, D₂define various zones 2110, 2112, 2114 in which the control system 1533causes the robotic surgical system 150 to exhibit different behaviors orproperties. For example, a control circuit 1532 executing the process2050 can cause the robotic surgical system 150 to operate in a defaultgross motion mode within the zone 2114, an intermediate or adjustablegross motion mode within the zone 2112, and/or a fine-movement modewithin the zone 2110.

In one example, the default gross motion mode is applied to the movementof the surgical tool while the distance d_(t) between the surgical tooland the tissue of the patient is greater than or equal to the thresholddistance D₂. Additionally, or alternatively, the adjustable gross motionmode is applied to the movement of the surgical tool while the distanced_(t) between the surgical tool and the tissue of the patient is betweenthe threshold distances D₁ and D₂. Additionally, or alternatively, thefine-movement mode is applied to the movement of the surgical tool whilethe distance d_(t) between the surgical tool and the tissue of thepatient is less than the threshold distance D₁.

As described above, the movement of the surgical tool is scaled to theuser input force according to the distance d_(t). In various examples,the movement of the surgical tool is scaled to the user input force in amanner that generates a greater speed for a given user input forcewithin the zone 2114 in comparison to the same given force within zones2112 and 2110. In other words, the movement of the surgical tool isscaled to the user input force in a manner that requires a lesser userinput force to move the surgical tool at a particular rate of motionwithin the zone 2114 in comparison to the zones 2112 and 2110.

In various examples, the movement of the surgical tool is scaled to theuser input force in a manner that generates a lesser speed for a givenuser input force within the zone 2110 in comparison to the same givenforce within zones 2112 and 2114. In other words, the movement of thesurgical tool is scaled to the user input force in a manner thatrequires a greater user input force to move the surgical tool at aparticular rate of motion within the zone 2110 in comparison to thezones 2112 and 2114.

In various examples, a default maximum scale factor or scale factorrange is utilized to scale the movement of the surgical tool to the userinput force in the zone 2114. Additionally, or alternatively, a defaultminimum scale factor or scale factor range is utilized to scale themovement of the surgical tool to the user input force in the zone 2110.Additionally, or alternatively, an adjustable scale factor or scalefactor range is utilized to scale the movement of the surgical tool tothe user input force in the zone 2112.

In various aspects, the control circuit 1532 can adjust the scaling ofthe movement of the surgical tool to the user input force via a linear,or substantially linear, algorithm or other types of algorithms. Stillfurther, the control circuit 1532 can cause the robotic surgical system150 to deactivate the gross motion controls, i.e., only permit finemotion of the surgical system 150, when the robotic surgical systemcomponent is within a third zone 2110.

Although the examples described above track a user input force and scalethe movement of the surgical tool to the user input force, it isforeseeable to track a user input movement and scale the movement of thesurgical tool to the user input movement or to the combined user inputforce and user input movement, as detected by the input control device1000.

In effect, a control circuit 1532 executing the processes 2000, 2050permits gross motion by the robotic surgical system 150 when a componentthereof is far from the patient and enforces finer movement by therobotic surgical system 150 when the component is near the patient. Byadjustably scaling the movement of the robotic surgical system 150according to the proximity to the patient, the robotic surgical system150 can allow quicker movement of surgical tools 1050 controlled by therobotic surgical system 150 through the unoccupied areas that are farfrom the patient so that a surgeon does not have to repeatedly clutchout of the controls when trying to move the surgical tools 1050relatively large distances to the patient. Further, the robotic surgicalsystem 150 can automatically switch to a fine or precision movement modeas the surgical tools 150 approach the patient.

In various aspects, the gross motions described in the presentdisclosure are gross translational motions characterized by speedsselected from a range of about 3 inches/second to about 4 inches/second.In at least one example, a gross translational motion, in accordancewith the present disclosure, is about 3.5 inches/second. In variousaspects, by contrast, the fine motions described in the presentdisclosure can be fine translational motions characterized by speedsless than or equal to 1.5 inch/second. In various aspects, the finemotions described in the present disclosure can be fine translationalmotions characterized by speeds selected from a range of about 0.5inches/second to about 2.5 inches/second.

In various aspects, the gross motions described in the presentdisclosure are gross rotational motions characterized by speeds selectedfrom a range of about 10 radians/second to about 14 radians/second. Inat least one example, a gross rotational motion, in accordance with thepresent disclosure, is about 12.6 radians/second. In various aspects, bycontrast, the fine motions described in the present disclosure can befine rotational motions characterized by speeds selected from a range ofabout 2 radians/second to about 4 radians/second. In at least oneexample, a fine rotational motion, in accordance with the presentdisclosure, is about 2.3 radians/second.

In various aspects, the gross motions of the present disclosure are twoto six times greater than the fine motions. In various aspects, thegross motions of the present disclosure are three to five times greaterthan the fine motions.

Scaling Camera Magnification According to Tissue Proximity

Many robotic surgical systems force users to manually adjust themagnification or FOV of the visualization system during the course of asurgical procedure. However, this can force users to divert theirattention from the surgical task at hand, which can cause mistakesduring the surgical procedure and force surgeons to reorient themselveseach time the magnification is changed, which can take up time duringthe surgical procedure. Therefore, it can be desirable for thevisualization system 1500 associated with a robotic surgical system 150to automatically adjust or scale its magnification depending upon theneeds of the surgeon during the surgical procedure.

Accordingly, a visualization system 1500 for a robotic surgical system150 can be configured to control the magnification of a camera 1520(FIG. 8) in use during the surgical procedure as a function of thedistance between a robotic surgical system component, such as a surgicaltool 1050 or an end effector 1052 thereof, and the patient. For example,FIG. 17 is a logic flow diagram of a process 2200 for controlling avisualization system 1500 of a robotic surgical system, in accordancewith at least one aspect of the present disclosure. The process 2200 canbe executed by a control circuit of a computer system, such as theprocessor 158 of the robotic surgical system 150 illustrated in FIG. 3or the control circuit 1532 of the control system 1533 illustrated inFIG. 9. Accordingly, the process 2200 can be embodied as a set ofcomputer-executable instructions stored in a memory 1534 (FIG. 9) that,when executed by the control circuit 1532, cause the computer system(e.g., the control system 1533) to perform the described instructions.Further, although the process 2200 depicted in FIG. 17 is described asbeing executed by a control circuit 1532 of a control system 1533, thisis merely for brevity, and it should be understood that the depictedprocess 2200 can be executed by circuitry that can include a variety ofhardware and/or software components and may be located in or associatedwith various systems integral or connected to a robotic surgical system150.

Accordingly, a control circuit 1532 executing the process 2200determines 2202 the distance d_(t) between a component of the roboticsurgical system 150, such as a surgical tool 1050 or an end effector1052 thereof, and the patient. The control circuit 1532 can measure thedistance d_(t) utilizing TOF, structured light, and other suchtechniques via the visualization system 1500 described above under theheading SURGICAL VISUALIZATION SYSTEMS, for example.

Accordingly, the control circuit 1532 sets 2204 the magnification of thevisualization system 1500 based on the distance d_(t). The relationshipbetween the visualization system magnification and the distance d_(t)can be defined algorithmically, represented by a series of magnificationvalues stored in a lookup table or other storage that are indexedaccording to distance values and so on. For example, the relationshipbetween the distance d_(t) and the visualization system magnificationcan be linear, nonlinear, binary, and so on. Further, the relationshipbetween the distance d_(t) and the visualization system magnificationcan correspond to modes or settings that are selectable by users of thevisualization system 1500. The control circuit 1532 can be configured tocontinue to monitor the position of the robotic surgical systemcomponent and the patient and control the visualization system 1500accordingly throughout the course of the surgical procedure.

FIGS. 18 and 19 are graphs 2250, 2300 of the magnification and FOV,respectively, of the visualization system 1500 versus the distance d_(t)between the robotic surgical system component and the patient accordingto prophetic implementations of the process 2200 illustrated in FIG. 17.In the first graph 2250, the vertical axis 2252 represents themagnification of the visualization system 1500 and the horizontal axis2254 represents the distance d_(t) between the robotic surgical systemcomponent and the patient. The first line 2256 and the second line 2258represent the relationship between magnification and the distance d_(t)in different implementations of the process 2200. In the implementationrepresented by the first line 2256, the visualization systemmagnification is linearly related to the distance d_(t) such that themagnification increases linearly as the distance d_(t) decreases (as therobotic surgical system component approaches the patient tissue).Accordingly, the control circuit 1532 can set 2204 the visualizationsystem magnification based on the distance d_(t) utilizing a linearalgorithm, for example. In the implementation represented by the secondline 2258, the visualization system magnification is related to thedistance d_(t) by a binary relationship, i.e., once the distance d_(t)reaches a threshold value D_(z1), the magnification increases from afirst value to a second value. Accordingly, the control circuit 1532 canset 2204 the visualization system magnification based on the distanced_(t) utilizing a step function where the control circuit 1532 sets 2204the visualization system 1500 to a first magnification if d_(t) is lessthan D_(z1) or a second magnification if d_(t) is greater than or equalto D_(z1).

In the second graph 2300, the vertical axis 2302 represents the FOV ofthe visualization system 1500 and the horizontal axis 2304 representsthe distance d_(t) between the robotic surgical system component and thepatient. The third line 2306 represents the relationship betweenmagnification and the distance d_(t) in another implementations of theprocess 2200. In the implementation represented by the third line 2306,the visualization system FOV is nonlinearly related to the distanced_(t) such that the FOV gradually decreases (i.e., the magnificationincreases) as the distance d_(t) decreases (as the robotic surgicalsystem component approaches the patient tissue) until the distance d_(t)reaches a threshold distance D_(z2). At and/or below the thresholddistance D_(z2), the visualization system magnification is set to aparticular predetermined value.

Accordingly, the control circuit 1532 can set 2204 the visualizationsystem FOV based on the distance d_(t) by comparing the distance d_(t)to the threshold value D_(z2) and either setting the visualizationsystem FOV to a calculated FOV value if the distance d_(t) is greaterthan or equal to the threshold D_(z2) or setting the visualizationsystem FOV to a predetermined FOV value if the distance d_(t) is lessthan or equal to the threshold D_(z2). This implementation causes thevisualization system 1500 to gradually decrease its FOV as a surgicaltool 1050 (or other robotic system component) approaches the patient andthen, once the surgical tool 1050 is at or closer than a particulardistance from the patient, set the FOV to a particular value so thatfurther movement of the surgical tool 1050 within a zone 2301 defined bythe threshold distance D_(z2) thereby maintaining the FOV within thezone 2301.

In effect, a control circuit 1532 executing the process 2200automatically sets the magnification of the visualization system 1500 toan appropriate level based on the proximity of a surgical tool 1050 oranother robotic surgical system component to the patient. When thesurgical tool 1050 is far from the patient, the visualization system1500 can be set to a low magnification to provide a large FOV to thesurgeon suitable for visualizing gross motions by the surgical tool 1050and viewing anatomy adjacent to the surgical site. Conversely, when thesurgical tool 1050 is in close proximity to the patient, thevisualization system 1500 can be set to a high magnification to providea tight FOV suitable for performing precise and delicate movements withthe surgical tool 1050. In various aspects, the FOV is adjusted bychanging the magnification.

Location Tagging

During a surgical procedure, there may be particular structures orlandmarks that a surgeon may wish to return to throughout the procedureor that the surgeon desires to be particularly cautious of when moving asurgical tool 1050 near (e.g., a structure that may shift or move duringthe surgical procedure). Accordingly, in some aspects the roboticsurgical system 150 can be configured to allow users to tag or selectcertain locations prior to and/or during the surgical procedure. Invarious aspects, tagged locations can be returned to automaticallyduring the surgical procedure, which can reduce the amount of physicalmanipulation that surgeons are required to perform, and/or define zonesthrough which the robotic surgical system 150 is to move any surgicaltools 1050 or other components more slowly, which can improve the safetyin using the robotic surgical system 150.

In one aspect, the robotic surgical system 150 provides a user interfacevia, for example, a display 160 (FIG. 3) that users can utilize to markparticular locations or other points of interest during a surgicalprocedure. Once marked, the robotic surgical system 150 canautomatically return to the selected location or perform variousfunctions when a surgical tool 1050 or another component of the roboticsurgical system 150 is located within a zone defined by the selectedlocation.

FIGS. 20 and 21 are various views of a robotic surgical system userinterface for tagging locations, in accordance with at least one aspectof the present disclosure. A user can tag a location by, for example,selecting a location on a display 160 and displaying a video feed fromthe surgical procedure and/or other information captured by thevisualization system 1500. The display 160 can include, for example, atouchscreen display on which users can directly select a location. Onceselected, the control circuit 1532 can determine the coordinates of thetissue located at the selected point by, for example, mapping thesurface of the tissue and determining what location on the mapped tissuethe selected point corresponds to using one or more of theaforementioned techniques for mapping a tissue surface. The controlcircuit 1532 can then save the coordinates of the selected location(e.g., in the memory 1534). In one aspect, the control circuit 1532 canbe configured to control the robotic surgical system 150 to move thesurgical tool 1050 to a position that corresponds to the coordinates forthe selected location. For example, the control circuit 1532 can beconfigured to move the surgical tool 1050 such that it is positionedabove the coordinates for the selected location.

In one aspect, the robotic surgical system 150 can be configured todefine zones around the selected or tagged locations. The tagged zonescan be defined algorithmically based upon the tagged location selectedby the user, tissue parameters associated with the tissue at or adjacentto the tagged location, and so on. In the aspect illustrated in FIGS. 20and 21, the tagged location 2452 is the point selected by the user, asdescribed above, and the tagged zone 2450 is the zone defined around thetagged location 2452. In the depicted aspect, the tagged zone 2450 isdefined as the zone of height H above the surface of the tissue 2460,length L along the surface of the tissue 2460, and width W along thesurface of the tissue 2460, wherein the tagged location 2452 ispositioned, or substantially positioned, at the midpoint of the taggedzone 2450. Accordingly, the tagged zones 2450 are defined based upon thelocation of the particular tagged location 2452. Accordingly, the taggedzones 2450 can be defined and updated in real time during a surgicalprocedure and displayed on a display 160 or another visualizationsystem. In some aspects, the tagged zones 2450 and/or tagged locations2452 can be overlaid on the video feed relayed from a camera 1520 oranother component of the visualization system 1500.

In another aspect, the tagged zones 2450 can be created preoperatively,rather than intraoperatively, by scanning the tissue surface via apreoperative CT scan, MRI scan, or other scanning technique. A controlsystem can then model the tissue surface and any locations of interestcan be tagged. Thereafter, the control system can save thepreoperatively defined tagged zones 2450 and control the function(s) ofthe robotic surgical system 150 according to the predefined tagged zones2450 during the course of the surgical procedure.

In one aspect, the robotic surgical system 150 can be configured tochange its functionality when a surgical tool 1050 controlled by therobotic surgical system 150 is at or within the tagged zone. Forexample, FIG. 22 is a logic flow diagram of a process 2400 forcontrolling a robotic surgical system 150 according to whether acomponent thereof is positioned within a tagged zone, in accordance withat least one aspect of the present disclosure. The process 2400 can beexecuted by a control circuit of a computer system, such as theprocessor 158 of the robotic surgical system 150 illustrated in FIG. 3or the control circuit 1532 of the control system 1533 illustrated inFIG. 9. Accordingly, the process 2400 can be embodied as a set ofcomputer-executable instructions stored in a memory 1534 (FIG. 9) that,when executed by the control circuit 1532, cause the computer system(e.g., the control system 1533) to perform the described steps. Further,although the process 2400 depicted in FIG. 22 is described as beingexecuted by a control circuit 1532 of a control system 1533, this ismerely for brevity, and it should be understood that the depictedprocess 2400 can be executed by circuitry that can include a variety ofhardware and/or software components and may be located in or associatedwith various systems integral or connected to a robotic surgical system150.

Accordingly, a control circuit 1532 executing the process 2400determines 2402 the position of a surgical tool 1050 controlled by therobotic surgical system 150 via the techniques discussed above under theheading SURGICAL VISUALIZATION SYSTEMS, for example. Accordingly, thecontrol circuit 1532 determines 2404 whether the position of thesurgical tool 1050 lies at or within one of the tagged zones 2450 (whichcan be defined preoperatively or intraoperatively). If the surgical toolposition does intersect with one of the tagged zones 2450, the process2400 proceeds along the YES branch and the control circuit 1532 sets2406 the robotic surgical system 150 to a fine or precision movementmode (e.g., from a gross motion mode). If the surgical tool positiondoes not intersect with one of the tagged zones 2450, the process 2400proceeds along the NO branch and the control circuit 1532 operates 2408normally or according to other processes. Regardless, the controlcircuit 1532 can continue monitoring the position of the surgical tool1050 to determine whether the surgical tool 1050 is located within atagged zone 2450 and controlling the robotic surgical system 150accordingly throughout the surgical procedure.

In effect, a control circuit 1532 executing the process 2400 switchesthe robotic surgical system 150 into a fine-movement mode when asurgical tool 1050 enters the area around a location of interest thathas been tagged by a user. Therefore, users can tag particular locationsnear which they want the robotic surgical system 150 to be particularlycautious in moving a surgical tool 1050 or where more precise control ofthe robotic surgical system 150 is otherwise desired.

Scaling Surgical System Movement According to Camera Magnification

In robotic surgery, properly scaling the motion of the surgical toolrelative to surgeon input motion is critical for two reasons. First, itis very important that that the surgeon is able to accurately move thesurgical tools during a surgical procedure because many surgical tasksrequire precise motions to complete, and inaccurate movements withsurgical tools risk causing harm to the patient. Second, the overalluser experience associated with the robotic surgical system must beintuitive and comfortable because unintuitive controls can create morerisks for mistakes and can cause surgical procedures to take more time,thereby requiring that the patient be under anesthesia for a longerperiod of time and potentially leading to surgeon fatigue. Therefore, itcan be desirable to scale the robotic surgical system motion to thesurgeon input motion in a manner that promotes an intuitive userexperience in controlling the robotic surgical system.

Some evidence has indicated that scaling the surgeon input motionaccording to the perceived on-screen motion of the surgical tools makesfor an intuitive user experience in controlling the surgical tools. Theperceived on-screen motion of the surgical tools is affected by themagnification and other lens parameters associated with thevisualization system 1500 or a camera 1520 thereof. Accordingly, variousprocesses can be implemented to correlate the robotic surgical systemoutput motion scaling and the magnification of the visualization system1500. For example, FIG. 23 is a logic flow diagram of a process 2500 forcontrolling the movement of a robotic surgical system according tocamera magnification. The process 2500 can be executed by a controlcircuit of a computer system, such as the processor 158 of the roboticsurgical system 150 illustrated in FIG. 3 or the control circuit 1532 ofthe control system 1533 illustrated in FIG. 9. Accordingly, the process2500 can be embodied as a set of computer-executable instructions storedin a memory 1534 (FIG. 9) that, when executed by the control circuit1532, cause the computer system (e.g., the control system 1533) toperform the described steps. Further, although the process 2500 depictedin FIG. 23 is described as being executed by a control circuit 1532 of acontrol system 1533, this is merely for brevity, and it should beunderstood that the depicted process 2500 can be executed by circuitrythat can include a variety of hardware and/or software components andmay be located in or associated with various systems integral orconnected to a robotic surgical system 150.

Accordingly, the control circuit 1532 executing the process 2500determines 2502 the current magnification of the visualization system1500. In one aspect, the visualization system 1500, the camera 1520, ora control system thereof is configured to continually update a memory ordatabase with the current magnification value at which the visualizationsystem 1500 is set. In such an aspect, the control circuit 1532 candetermine 2502 the visualization system 1500 magnification by retrievingthe magnification value reflecting the current magnification of thevisualization system 1500 from the memory or database. In anotheraspect, the control circuit 1532 can be configured to determine 2502 thevisualization system 1500 magnification from parameters associated withthe visualization system 1500. For example, the visualization system1500 magnification can be based on the distance from the endoscopecamera lens to the subject tissue, the distance of a surgical tool to asubject tissue, and/or camera lens parameters.

In various aspects, the control circuit 1532 is configured to set thevisualization system 1500 magnification based on the distance betweenthe camera 1520 of the visualization system 1500 and the patient'stissue as a proxy for the actual visualization system magnification.Furthermore, the control circuit 1532 can be configured to set thevisualization system 1500 visual scaling based on the motion scaling ofthe camera 1520 relative to the patient's tissue. In various aspects, asthe camera 1520 moves closer to the subject tissue, which causes theimage observed by the camera 1520 to be magnified, the motion scalingfactor decreases to enable precise motions thereby maintaining, orsubstantially maintaining, a 1-to-1 relationship between input motionswith perceived on-screen motions. Other scaling factors can also beapplied based on other measured distances.

The control circuit 1532 can determine the camera-to-tissue distance by,for example, utilizing structured light and/or other techniquesdescribed above under the heading SURGICAL VISUALIZATION SYSTEMS tocalculate the distance between the visualization system 1500 and thetissue and/or critical structures. This or other visualization system1500 parameters can then be utilized as a baseline for scaling theoutput motion of the robotic system based on the surgeon input motion.

Accordingly, the control circuit 1532 scales 2504 the movement of therobotic surgical system component based on the actual or estimatedvisualization system magnification. In one aspect, the control circuit1532 can scale 2504 the robotic surgical system component movement byapplying a scale factor that is applied to the generated control signalsfor controlling the movement of the various components of the roboticsurgical system component to produce the robotic surgical system outputmotion. The relationship between the visualization system magnificationand the scaling applied to the robotic surgical system componentmovement can be defined algorithmically (which can be computed atrun-time or pre-calculated for particular values), represented by aseries of movement scale factors stored in a (e.g., prefetched) lookuptable or other storage that are indexed according to magnificationvalues, and so on. In various aspects, the control circuit 1532 cancontinue monitoring the visualization system magnification and adjustingthe output movement of the robotic surgical system component accordinglythroughout a surgical procedure.

FIG. 24 is a graph 2550 of the magnification of the camera assemblyversus the distance between the robotic surgical system component andthe patient according to prophetic implementations of the process 2500illustrated in FIG. 23. The vertical axis 2552 represents the movementscale factor μ and the horizontal axis 2554 represents the magnificationof the visualization system 1500. As represented in this particulargraph 2550, as the magnitude of the scale factor μ increases verticallyalong the vertical axis 2552, the relative output movement of therobotic surgical system is decreased, requiring more input motion by theuser to move the surgical tools 1050 a smaller distance. The first line2560 and the second line 2562 represent examples of the relationshipbetween the movement scale factor μ and the visualization systemmagnification in different implementations of the process 2550.

In one aspect, represented by the first line 2560, there is a non-linearrelationship between the movement scale factor μ and the visualizationsystem magnification. In another aspect, represented by the second line2562, there is a linear relationship between the movement scale factor μand the visualization system magnification. In this aspect, themagnitude of scaling of the robotic surgical system component movementdecreases as the robotic surgical system component, for example, thecamera 1520, approaches the tissue and/or critical structure. In variousaspects, the amount or character (e.g., linear or non-linear) of scalingof the robotic surgical system component movement relative to thevisualization system magnification can be selected by the user. Invarious other aspects, various other parameters associated with thevisualization system 1500 and/or distances between the patient and therobotic surgical system components are selected by the user.

In effect, a control circuit 1532 executing the process 2500 causes themovement of the robotic surgical system component to decrease inresponse to input from an input control device 1000 (i.e., become moreprecise) as the magnification of the visualization system 1500increases. In various aspects, the magnification of the visualizationsystem 1500 can be retrieved from a memory or determined indirectly bymonitoring a parameter associated with the visualization system 1500,such as the distance between a camera 1520 of the visualization system1500 and the tissue (because as the camera 1520 moves closer to thetissue, the image produced by the camera 1520 is magnified). Therefore,the output movement of the robotic surgical system is intuitively scaledto the perceived on-screen motion of the robotic surgical systemcomponent.

Locking End Effector According to Tissue Proximity

Various drive mechanisms for manipulating a robotic surgical tool, suchas cable drive mechanisms, are disclosed in U.S. Pat. No. 8,224,484,titled METHODS OF USER INTERFACE WITH ALTERNATE TOOL MODE FOR ROBOTICSURGICAL TOOLS, which is hereby incorporated by reference herein in itsentirety. Articulating, manipulating, or otherwise actuating an endeffector 1052 (FIG. 7) while moving the end effector 1052 toward apatient, for example, in gross motion mode, may cause the end effector1052 to unintentionally contact or engage a tissue of the patient and/orother surgical tools positioned along the path of the end effector 1052and can place strain on the drive mechanism(s) of the surgical tool 1050and/or robotic surgical system 150 effectuating those movements. Thestrain placed on the cables or other drive mechanism components can,over time, cause those components to fail, which can cause damage to thesurgical tool 1050 and/or robotic surgical system 150 and necessitatecostly and time-consuming repairs.

The present disclosure provides various solutions for reducing theunintentional contact between a moving end effector 1052 and a tissue ofthe patient and/or other surgical tools and for minimizing the amount ofstress placed on the drive mechanism for controlling an end effector1052 in order to prolong the lifespan of the surgical tool 1050 and/orrobotic surgical system 150.

Various processes are implemented to reduce the unintentional contactbetween a moving end effector 1052 and a tissue of the patient and/orother surgical tools, and to minimize the stress placed on the endeffector drive mechanism(s), by maintaining the end effector 1052 in alocked configuration in a position where the drive mechanism(s) areunstressed or minimally stressed when there would generally be no needto actuate the end effector 1052. Maintaining the end effector 1052 inan unstressed position when there would be no need to actuate the endeffector 1052 reduces the overall amount of stress applied to the endeffector drive mechanism(s) by reducing the number of instances duringwhich the drive mechanisms are being stressed without sacrificing theusability of the end effector 1052.

FIGS. 25 and 26 are logic flow diagrams of processes for controlling anend effector to minimize unintentional contact or engagement between amoving end effector 1052 and a tissue of the patient and/or othersurgical tools positioned along the path of the end effector 1052, inaccordance with at least one aspect of the present disclosure. FIGS. 25Aand 26A are logic flow diagrams of processes for controlling an endeffector to reduce the amount of stress applied to the end effectordrive mechanism(s), in accordance with at least one aspect of thepresent disclosure.

The processes 2600, 2601, 2650, 2651 can be executed by a controlcircuit of a computer system, such as the processor 158 of the roboticsurgical system 150 illustrated in FIG. 3 or the control circuit 1532 ofthe control system 1533 illustrated in FIG. 9. Accordingly, theprocesses 2600, 2601, 2650, 2651 can be embodied as a set ofcomputer-executable instructions stored in a memory 1534 (FIG. 9) that,when executed by the control circuit 1532, cause the computer system(e.g., the control system 1533) to perform the described steps. Further,although the processes 2600, 2601, 2650, 2651 depicted in FIGS. 25-26Aare described as being executed by a control circuit 1532 of a controlsystem 1533, this is merely for brevity, and it should be understoodthat the depicted processes 2600, 2601, 2650, 2651 can be executed bycircuitry that can include a variety of hardware and/or softwarecomponents and may be located in or associated with various systemsintegral or connected to a robotic surgical system 150.

In certain aspects illustrated in FIGS. 25 and 25A, the processes 2600,2601 control whether the end effector 1052 is locked or unlockedaccording to the distance d_(t) between the end effector 1052 and thepatient. Accordingly, a control circuit 1532 executing the processes2600, 2601 determines 2602 the distance d_(t) between the end effector1052 and the patient. The control circuit 1532 can measure the distanced_(t) utilizing TOF, structured light, and other such techniques via thevisualization system 1500 described under the heading SURGICALVISUALIZATION SYSTEMS, for example.

Accordingly, the control circuit 1532 compares 2604 the distance d_(t)to a threshold distance. The control circuit 1532 can, for example,retrieve the threshold distance from a memory. In one aspect, thecontrol circuit 1532 can determine whether the distance d_(t) is greaterthan or equal to the threshold distance. The threshold distance cancorrespond to the distance at which the control of the surgical tool ischange from a gross control mode to a fine control mode. If the distanced_(t) is greater than or equal to the threshold, then the process 2600proceeds along the YES branch and the control circuit 1532 causes theend effector 1052 to be in a locked 2606 configuration. If the distanced_(t) is less than the threshold, then the process 2600 proceeds alongthe NO branch and the control circuit 1532 unlocks 2608 the end effector1052.

In the process 2601, however, an additional inquiry is made as towhether 2603 the end effector 1052 is in an unstressed position. If itis, the process 2601 proceeds along the YES branch and the controlcircuit 1532 locks 2607 the end effector 1052 in the unstressedposition. However, if the process 2601 determines that the end effector1052 is not in an unstressed position, the process 2601 proceeds alongthe NO branch and transitions 2605 the end effector 1052 to anunstressed position before locking 2607 the end effector 1052.

In other aspects illustrated in FIGS. 26 and 26A, the processes 2650,2651 control whether the end effector 1052 is locked or unlockedaccording to whether the robotic surgical system 150 is in the grossmotion mode. In some aspects, whether the robotic surgical system 150 isin the gross motion mode or the fine motion mode depends upon theposition of the surgical tool 1050 relative to the patient, as discussedabove with respect to FIGS. 14 and 15. Accordingly, a control circuit1532 executing the processes 2650, 2651 determines 2654 whether thegross motion mode for the robotic surgical system 150 is activated. Inone aspect, the control circuit 1532 can determine whether the roboticsurgical system 150 is in the gross motion mode by retrieving a currentstate variable from a memory, an output of a state machine, and so on.In some aspects, a control system (such as the control system 1533) canmaintain or update a current state variable or a state machinecorresponding to the state (e.g., mode or position) of the roboticsurgical system 150 and/or a surgical tool 1050 depending upon receivedinput or actions taken by the robotic surgical system 150 and/orsurgical tool 1050. Therefore, in these aspects, the control circuit1532 can determine 2654 whether the robotic surgical system 150 is inthe gross motion state by retrieving the value of this variable or theoutput the state machine.

If the robotic surgical system 150 is in the gross motion mode, theprocess 2650 proceeds along the YES branch and the control circuit 1532locks 2656 the end effector 1052. If, however, the robotic surgicalsystem 150 is not in the gross motion mode, then the process 2650proceeds along the NO branch and the control circuit 1532 unlocks 2658the end effector 1052.

In the process 2651, however, an additional inquiry is made as towhether 2653 the end effector 1052 is in an unstressed position. If itis, the process 2651 proceeds along the YES branch and the controlcircuit 1532 locks 2657 the end effector 1052 in the unstressedposition. However, if the process 2651 determines that the end effector1052 is not in an unstressed position, the process 2651 proceeds alongthe NO branch and transitions 2655 the end effector 1052 to anunstressed position before locking 2657 the end effector 1052.

In various aspects, a locked configuration is one that prevents the endeffector 1052 for articulating, rotating, and/or actuating in responseto a user input signal. The end effector 1052 can be lockedmechanically, electronically via software control, or in any othermanner that prevents control input (e.g., via the input control device1000) from causing the end effector 1052 to articulate, rotate, and/oropen and close its jaws. In particular, the end effector 1052 can belocked in a manner that prevents the cable assembly from straining orotherwise exerting force on the end effector 1052. As noted above,various systems and techniques for locking surgical drive mechanisms aredescribed in U.S. Pat. No. 8,224,484. When the end effector 1052 isunlocked, it can be actuated or otherwise controlled by a user via, forexample, an input control device 1000 to perform a surgical procedure,as described above under the heading INPUT CONTROL DEVICES.

In effect, the processes 2601, 2651 illustrated in FIGS. 25A and 26A canprevent or minimize the strain on the robotic drive mechanisms bylocking the joint of the end effector 1052 in an unstressed positionwhen there would generally be no need to actuate the end effector 1052,i.e., when the end effector 1052 is not in a close proximity to thepatient. The unstressed position can include, for example, a positionwhere the end effector 1052 is aligned with the longitudinal axis of thesurgical tool shaft (i.e., the X_(T) axis illustrated in FIG. 7).

Referring now to FIG. 27, in one aspect, the control circuit 1532 canfurther be configured to control an indicator 2660 based upon the lockstate of the surgical tool 1050. In particular, the control circuit 1532can be configured to shift the indicator 2660 between a first state anda second state according to whether the surgical tool 1050 is locked orunlocked. The indicator 2660 can include, for example, an LED configuredto illuminate in different colors or in different patterns (e.g., flashwhen locked), a speaker assembly configured to emit sounds or alerts, ora display 160 (FIG. 3) configured to present icons, graphics, or textualalerts. The indicator 2660 can be disposed on or associated with the endeffector 1052, the surgical tool 1050, the surgeon's console 116, 150(FIGS. 1, 2, and 4), and so on. For example, a control circuit 1532executing either or both of the processes 2600, 2650 can cause theindicator 2660 to illuminate in a first color when the surgical tool1050 is locked 2606, 2656 and a second color when the surgical tool 1050is unlocked 2608, 2658.

Selectable Variable Response of Shaft Motion

Referring now to FIG. 28, a graph 3001 represents four motion scalingprofiles 3002, 3004, 3006, 3008 of the motion of a surgical tool 1050(FIG. 7) with respect to a user input force 3010. The X-axis representsthe user input force 3010 and the Y-axis represents corresponding ratesof motion 3012 of the surgical tool 1050 in response to the user inputforce 3010 for each of the motion scaling profiles 3002, 3004, 3006,3008.

In at least one example, the user input force 3010 is detected by asensor arrangement 1048 (FIG. 9) in the base 1004 (FIG. 6) of the inputcontrol device 1000. When a user actuates the space joint 1006 (FIG. 6),the input control device 1000 transmits a motion control signal to thecontrol circuit 1532 (FIG. 9), for example. In at least one example, themotion control signal represents the value(s) of the user input force(s)3010 detected by the sensor arrangement 1048. The control circuit 1532then causes the surgical tool 1050 to move in response to the motioncontrol signal at rates of motion defined by the motion scaling profiles3002, 3004, 3006, 3008.

As illustrated in FIG. 28, a given user input force 3010 yields adifferent rate of motion for each one of the motion scaling profiles3002, 3004, 3006, 3008. For example, a first user input force F1 yieldsa first rate of motion V1 when the motion scaling profile 3004 isselected, and yields a second rate of motion V2 when the motion scalingprofile 3002 is selected.

FIG. 29 illustrates an example motion-scaling profile selector 3014 inthe form of a dial that includes four settings corresponding to the fourmotion scaling profiles 3002, 3004, 3006, 3008. A user may select adesired motion scaling profile through the selector 3014. Other forms ofthe selector 3014 are contemplated by the present disclosure. Theselector 3014 can be integrated with the input control device 1000. Forexample, the actuation buttons 1026, 1028 (FIG. 6) of the input controldevice 1000 can be assigned to motion scaling profiles. In at least oneexample, the selector 3014 is in the form of a touch screen, which canbe integrated with the input control device 1000. Alternatively, asillustrated in FIG. 30, the selector 3014 can be implemented in a pedaldevice 3016 that includes pedals 3018, 3020, 3022, for example, whichcan be assigned to various motion scaling profiles.

Although four motion scaling profiles are depicted in the graph 3001,more or less than four motion scaling profiles can be utilized. In oneexample, various motion scaling profiles (e.g. P1, P2, . . . , Pn) canbe stored in the memory 1534 (FIG. 9) in the form of a look up table3024, as illustrated in FIG. 31. The look up table 3024 represents theuser input forces (e.g. F1, F2, . . . , Fn) and corresponding rates ofmotion ((e.g. V_(a1), V_(a2), . . . , V_(an)), (e.g. V_(b1), V_(b2), . .. , V_(bn)), (e.g. V_(z1), V_(z2), . . . , V_(zn))) that are availablefor each of the motion scaling profiles. Alternatively, various motionscaling profiles can be stored in the memory 1534 in the form ofalgorithms, or any other suitable form.

In the example of FIGS. 28 and 31, actual rates of motion 3012 of thesurgical tool 1050 in response to user input forces 3010 are utilized torepresent the motion scaling profiles 3002, 3004, 3006, 3008. In otherexamples, a multiplier or any other parameter of the motion of thesurgical tool 1050 can be used to represent available motion scalingprofiles of a surgical tool 1050.

FIG. 32 depicts a process 3100 for moving a surgical tool 1050 and/or anend effector 1052 based on selected motion scaling profiles. In at leastone example, the process 3100 is executed by a control circuit such as,for example, the control circuit 1532. As illustrated in FIG. 32, theprocess 3100 includes receiving 3102 a user selection signal. In atleast one example, the user selection signal is received 3102 by thecontrol circuit 1532 from a motion-scaling profile selector 3014. Thereceived 3102 user selection signal may indicate a selection between afirst motion scaling profile of the motion of the surgical tool 1050 anda second motion scaling profile of the motion of the surgical tool 1050,wherein the first motion scaling profile is different than the secondmotion scaling profile. The process 3100 further includes receiving 3104a motion control signal from the input control device 1000 indicative ofa user input force 3010.

The process 3100 further includes causing 3106 the surgical tool 1050 tobe moved in response to the motion control signal in accordance with thefirst motion scaling profile or the second motion scaling profile basedon the user selection signal. Moving the surgical tool 1050 can beaccomplished using one or more motors, for example, as described abovein connection with FIGS. 1-6, for example.

In various examples, different motion scaling profiles are assigned tomotions of the surgical tool 1050 along different directions. Forexample, a first motion scaling profile can be assigned to a motion ofthe surgical tool 1050 along the X_(t) axis, while a second motionscaling profile, different than the first motion scaling profile, can beassigned to a motion of the surgical tool 1050 along the Y_(t) axis. Inother words, the user input forces 3010 can yield different rates ofmotion 3012 for motions of the surgical tool 1050 along different axesor for motions of the surgical tool 1050 in different directions. Acontrol circuit such as, for example, the control circuit 1532 maydetermine a desired direction of motion through the sensor arrangement1048 of the input control device 1000. The control circuit 1532 may thenselect a suitable motion scaling profile based on the detected directionof motion.

As described above, a user may select from a number of availableprofiles of motion scaling using the motion-scaling profile selector3014, but the user-selected motion scaling profiles can be furthertweaked or adjusted by the control circuit 1532 based upon certainfactors such as, for example, the direction of motion of the surgicaltool 1050. Other factors are also considered such as, for example,whether the input control device 1000 is in a gross motion mode or afine motion mode. In various examples, certain motion scaling profilesare only available to the user in only one of the gross motion mode andthe fine motion mode.

For example, the motion scaling profiles 3002, 3004, 3006, 3008 aregross motion scaling profiles that are available in a gross motion modeof the surgical input device 1000, and are configured to scale themotion of the surgical tool 1050 to user input forces 3010. Othersuitable motion scaling profiles can be employed to scale the motion ofthe end effector 1052 to the user input forces 3010, for example.

Further to the above, in certain examples, motion scaling profiles for asurgical tool 1050 and/or an end effector 1052 are automaticallyselected by a control circuit such as, for example, the control circuit1532. In one example, the motion scaling profiles can be automaticallyselected based on the distance between the surgical tool 1050 and apatient, in accordance with a process 3500. As illustrated in FIG. 33,the process 3500 includes receiving 3502 a motion control signal fromthe input control device 1000 indicative of a user input force 3010, anddetermining 3504 a distance d_(t) between the surgical tool and apatient, which can be accomplished using one or more of the techniquesdescribed above under the heading “Surgical Visualization Systems.” Inat least one example, the process 3500 may determine 3404 the distanced_(t) by transmitting an electromagnetic wave from the surgical tool1050 to the patient, and calculating a time-of-flight of theelectromagnetic wave reflected by the patient.

The process 3500 further includes selecting 3506 between predeterminedmotion scaling profiles based on the determined distance d_(t). Theprocess 3500 further includes causing 3508 the surgical tool 1050 to bemoved in response to the motion control signal in accordance theselected motion scaling profile. Moving the surgical tool 1050 can beaccomplished using one or more motors, for example, as described abovein connection with FIGS. 1-6, for example.

In various aspects, the process 3500 further includes the distance d_(t)to a threshold distance. In at least one example, the threshold distancecan be stored in a memory 1534. The control circuit 1532 may retrievethe threshold distance from the memory 1534 and perform the comparison.In at least one example, the process 3500 includes selecting the firstmotion scaling profile if the distance is greater than or equal to thethreshold distance. In another example, the process 3500 includesselecting the second motion scaling profile if the distance is less thanor equal to the threshold distance.

Referring now to FIG. 34, a process 3600 is depicted. In at least oneexample, the process 3600 is executed by a control circuit such as, forexample, the control circuit 1532. The process 3600 includes receiving3602 a first motion control signal from the input control device 1000indicative of a first user input force, and receiving a second motioncontrol signal from the input control device 1000 indicative of a seconduser input force different than the first user input force. The process3600 further includes causing 3606 the surgical tool 1050 to be moved ata predetermined rate of motion in response the first motion controlsignal, and causing 3608 the surgical tool 1050 to be moved at the samepredetermined rate of motion in response the second motion controlsignal. In other words, two different user input forces may yield thesame rate of motion of the surgical tool 1050. In at least one example,a control circuit such as, for example, the control circuit 1532 mayselect the same rate of motion of the surgical tool 1050 in response toa first user input force in a gross motion mode, and in response to asecond user input force in a fine motion mode.

EXAMPLES

Various aspects of the subject matter described herein are set out inthe following numbered examples:

A list of Examples follows:

Example 1

-   -   A surgical system comprising a surgical tool, a motor operably        coupled to the surgical tool, and a control circuit coupled to        the motor. The control circuit is configured to receive an        instrument motion control signal indicative of a user input,        cause the motor to move the surgical tool in response to the        instrument motion control signal, receive an input signal        indicative of a distance between the surgical tool and tissue,        and scale the movement of the surgical tool to the user input in        accordance with the input signal.

Example 2

-   -   The surgical system of Example 1, wherein the control circuit is        configured to scale the movement of the surgical tool to the        user input while the distance is greater than or equal to a        threshold.

Example 3

-   -   The surgical system of Example 2, wherein the control circuit is        configured to deactivate the scaling of the movement of the        surgical tool to the user input when the distance is below the        threshold.

Example 4

-   -   The surgical system of Examples 2 or 3, wherein the threshold is        a first threshold. The control circuit is configured to adjust        the scaling in accordance with the distance while the distance        is between the first threshold and a second threshold.

Example 5

-   -   The surgical system of any one of Examples 1-4, wherein the        control circuit is configured to determine the distance between        the surgical tool and the tissue by causing a transmission of an        electromagnetic wave from the surgical tool to the tissue and        calculating a time-of-flight of the electromagnetic wave        reflected by the tissue.

Example 6

-   -   The surgical system of any one of Examples 1-5, further        comprising an input control device configured to transmit the        instrument motion control signal to the control circuit.

Example 7

-   -   The surgical system of Example 6, wherein the input control        device comprises a sensor for measuring a parameter of the user        input.

Example 8

-   -   The surgical system of Example 7, wherein the sensor is a force        sensor and the parameter is a force applied to the input control        device.

Example 9

-   -   The surgical system of any one of Examples 1-8, wherein scaling        the movement of the surgical tool comprises adjusting a force        required to move the surgical tool at a given speed.

Example 10

-   -   A surgical system comprising a surgical tool, a motor operably        coupled to the surgical tool, and a control circuit coupled to        the motor. The control circuit is configured to receive an        instrument motion control signal indicative of a user input,        cause the motor to move the surgical tool in response to the        instrument motion control signal, determine a distance between        the surgical tool and tissue, and scale the movement of the        surgical tool to the user input in accordance with the distance.

Example 11

-   -   The surgical system of Example 10, wherein the control circuit        is configured to scale the movement of the surgical tool to the        user input while the distance is greater than or equal to a        threshold.

Example 12

-   -   The surgical system of Example 11, wherein the control circuit        is configured to deactivate the scaling of the movement of the        surgical tool to the user input when the distance is below the        threshold.

Example 13

-   -   The surgical system of Examples 11 or 12, wherein the threshold        is a first threshold. The control circuit is configured to        adjust the scaling in accordance with the distance while the        distance is between the first threshold and a second threshold.

Example 14

-   -   The surgical system of any one of Examples 10-13, wherein        determining the distance between the surgical tool and the        tissue comprises causing a transmission of an electromagnetic        wave from the surgical tool to the tissue and calculating a        time-of-flight of the electromagnetic wave reflected by the        tissue.

Example 15

-   -   The surgical system of any one of Examples 10-14, further        comprising an input control device configured to transmit the        instrument motion control signal to the control circuit.

Example 16

-   -   The surgical system of Example 15, wherein the input control        device comprises a sensor for measuring a parameter of the user        input.

Example 17

-   -   The surgical system of Example 16, wherein the sensor is a force        sensor and the parameter is a force applied to the input control        device.

Example 18

-   -   A surgical system comprising a surgical tool, a motor operably        coupled to the surgical tool, and a control circuit coupled to        the motor. The control circuit is configured to receive an        instrument motion control signal indicative of a user input,        cause the motor to move the surgical tool in response to the        instrument motion control signal, receive an input signal        indicative of a distance between the surgical tool and tissue,        and select between a gross motion mode and a fine motion mode of        the surgical tool based on distance between the surgical tool        and the tissue.

Example 19

-   -   The surgical system of Example 18, wherein the control circuit        is configured to select the gross motion mode when the input        signal is indicative of a distance greater than or equal to a        threshold.

Example 20

-   -   The surgical system of Example 18, wherein the control circuit        is configured to select the fine motion mode when the input        signal is indicative of a distance less than or equal to a        threshold.

Another list of examples follow:

Example 1

-   -   A surgical visualization system for use with a robotic surgical        system that includes a surgical tool movable with respect to a        tissue of a patient in response to an instrument motion control        signal. The surgical visualization system comprises a camera and        a control circuit coupled to the camera. The control circuit is        configured to determine a distance between the surgical tool and        the tissue and adjust a magnification of the camera based on the        distance between the surgical tool and the tissue.

Example 2

-   -   The surgical visualization system of Example 1, wherein        adjusting the magnification of the camera comprises retrieving a        magnification value from a memory.

Example 3

-   -   The surgical visualization system of Examples 1 or 2, wherein        determining the distance between the surgical tool and the        tissue comprises receiving a signal indicative of a distance        value.

Example 4

-   -   The surgical visualization system of Examples 1 or 2, wherein        determining the distance between the surgical tool and the        tissue comprises causing a transmission of an electromagnetic        wave to the tissue and calculating a time-of-flight of the        electromagnetic wave reflected by the tissue.

Example 5

-   -   The surgical visualization system of any one of Examples 1-4,        wherein the magnification is linearly scaled to movement of the        surgical tool.

Example 6

-   -   The surgical visualization system of any one of Examples 1-4,        wherein the magnification is non-linearly scaled to movement of        the surgical tool.

Example 7

-   -   The surgical visualization system of any one of Examples 1-6,        further comprising a toggling mechanism for switching the        surgical visualization system between automatic magnification        and manual magnification.

Example 8

-   -   A robotic surgical system comprising a surgical visualization        system, an input control device, and a robotic surgical system        component movable with respect to a tissue of a patient in        response to an instrument motion control signal generated by the        input control device in response to a user input. The robotic        surgical system further comprises a control circuit configured        to determine a distance between the robotic surgical system        component and the tissue and set a field of view of the surgical        visualization system in accordance with the distance between the        robotic surgical system component and the tissue.

Example 9

-   -   The robotic surgical system of Example 8, wherein the robotic        surgical system component comprises a camera.

Example 10

-   -   The robotic surgical system of Examples 8 or 9, wherein        determining the distance between the robotic surgical system        component and the tissue comprises causing a transmission of an        electromagnetic wave to the tissue and calculating a        time-of-flight of the electromagnetic wave reflected by the        tissue.

Example 11

-   -   The robotic surgical system of Examples 8 or 9, wherein        determining the distance between the robotic surgical system        component and the tissue comprises receiving a signal indicative        of a distance value.

Example 12

-   -   The robotic surgical system of any one of Examples 8-11, wherein        setting the field of view of the surgical visualization system        comprises gradually adjusting.

Example 13

-   -   The robotic surgical system of any one of Examples 8-11, wherein        setting the field of view of the surgical visualization system        comprising selecting between a first field of view and a second        field of view.

Example 14

-   -   A robotic surgical system comprising a surgical visualization        system, an input control device, and a robotic surgical system        component movable with respect to a tissue of a patient in        response to an instrument motion control signal generated by the        input control device in response to a user input. The robotic        surgical system further comprises a control circuit configured        to determine a distance between the robotic surgical system        component and the tissue, select between a gross motion mode and        a fine motion mode of the robotic surgical system component        based on the distance between the robotic surgical system        component and the tissue, and increase a field of view of the        surgical visualization system in the gross motion mode.

Example 15

-   -   The robotic surgical system of Example 14, wherein the robotic        surgical system component comprises a camera.

Example 16

-   -   The robotic surgical system of Examples 14 or 15, wherein        determining the distance between the robotic surgical system        component and the tissue comprises causing a transmission of an        electromagnetic wave to the tissue and calculating a        time-of-flight of the electromagnetic wave reflected by the        tissue.

Example 17

-   -   The robotic surgical system of Examples 14 or 15, wherein        determining the distance between the robotic surgical system        component and the tissue comprises receiving a signal indicative        of a distance value.

Example 18

-   -   The robotic surgical system of any one of Examples 14-17,        wherein increasing the field of view is a gradual increase.

Example 19

-   -   A robotic surgical system comprising a surgical visualization        system and a surgical tool movable with respect to a tissue of a        patient. The robotic surgical system further comprises a control        circuit configured to receive a user input signal indicative of        a user input identifying a target location in the tissue,        identify a target zone with respect to the target location,        determine a distance between the surgical tool and the target        zone, and select between a gross motion mode and a fine motion        mode of the surgical tool based on the distance between the        surgical tool and the target zone.

Example 20

-   -   The robotic surgical system of Example 19, wherein the control        circuit is configured to cause the surgical tool to        automatically return to the target zone.

Another list of examples follow:

Example 1

-   -   A robotic surgical system comprising an end effector movable        relative to a tissue of a patient. The robotic surgical system        further comprises a control circuit configured to determine a        distance between the end effector and the tissue and cause the        end effector to be transitioned between a locked configuration        and an unlocked configuration based on the distance.

Example 2

-   -   The robotic surgical system of Example 1, wherein determining        the distance between the end effector and the tissue comprises        transmitting an electromagnetic wave from the end effector to        the tissue and calculating a time-of-flight of the        electromagnetic wave reflected by the tissue.

Example 3

-   -   The robotic surgical system of Examples 1 or 2, wherein the        control circuit is configured to cause the end effector to be in        the locked configuration if the distance is greater than or        equal to a predetermined threshold.

Example 4

-   -   The robotic surgical system of Examples 1 or 2, wherein the        control circuit is configured to cause the end effector to be in        the unlocked configuration if the distance is less than or equal        to a predetermined threshold.

Example 5

-   -   The robotic surgical system of any one of Examples 1-4, further        comprising an indicator. The indicator comprises a first state        representing the locked configuration and a second state        representing the unlocked configuration. The control circuit is        configured to switch the indicator between the first state and        the second state based on the distance.

Example 6

-   -   The robotic surgical system of Example 5, wherein the indicator        is disposed on the end effector.

Example 7

-   -   The robotic surgical system of any one of Examples 1 or 3-6,        wherein determining the distance between the end effector and        the tissue comprises receiving an input signal indicative of the        distance.

Example 8

-   -   The robotic surgical system of any one of Examples 1-7, wherein        the locked configuration comprises an electronic lock.

Example 9

-   -   A robotic surgical system comprising an end effector movable        relative to a tissue of a patient. The robotic surgical system        further comprises a control circuit configured to determine a        distance between the end effector and the tissue, determine that        the end effector is in an unstressed position, and maintain the        end effector in a locked configuration as long as the distance        remains greater than or equal to a predetermined threshold.

Example 10

-   -   The robotic surgical system of Example 9, wherein determining        the distance between the end effector and the tissue comprises        transmitting an electromagnetic wave from the end effector to        the tissue and calculating a time-of-flight of the        electromagnetic wave reflected by the tissue.

Example 11

-   -   The robotic surgical system of Examples 9 or 10, wherein the        control circuit is configured to cause the end effector to be in        an unlocked configuration if the distance is less than the        predetermined threshold.

Example 12

-   -   The robotic surgical system of any one of Examples 9-11, further        comprising an indicator. The indicator comprises a first state        representing the locked configuration and a second state        representing an unlocked configuration. The control circuit is        configured to switch the indicator between the first state and        the second state based on the distance.

Example 13

-   -   The robotic surgical system of Example 12, wherein the indicator        is disposed on the end effector.

Example 14

-   -   The robotic surgical system of any one of Examples 9 or 11-13,        wherein determining the distance between the end effector and        the tissue comprises receiving an input signal indicative of the        distance.

Example 15

-   -   The robotic surgical system of any one of Examples 9-14, wherein        the locked configuration comprises an electronic lock.

Example 16

-   -   A robotic surgical system comprising an end effector movable        relative to a tissue of a patient. The robotic surgical system        further comprises a control circuit configured to determine a        distance between the end effector and the tissue, determine that        the end effector is in a stressed position, cause the end        effector to be transitioned from the stressed position to an        unstressed position, cause the end effector to be in a locked        configuration in the unstressed position, and maintain the end        effector in the locked configuration as long as the distance        remains greater than or equal to a predetermined threshold.

Example 17

-   -   The robotic surgical system of Example 16, wherein determining        the distance between the end effector and the tissue comprises        transmitting an electromagnetic wave from the end effector to        the tissue and calculating a time-of-flight of the        electromagnetic wave reflected by the tissue.

Example 18

-   -   The robotic surgical system of Examples 16 or 17, wherein the        control circuit is configured to cause the end effector to be in        an unlocked configuration if the distance is less than the        predetermined threshold.

Example 19

-   -   The robotic surgical system of Example 16, further comprising an        indicator. The indicator comprises a first state representing        the locked configuration and a second state representing an        unlocked configuration. The control circuit is configured to        switch the indicator between the first state and the second        state based on the distance.

Example 20

-   -   The robotic surgical system of any one of Examples 16, 18, or        19, wherein determining the distance between the end effector        and the tissue comprises receiving an input signal indicative of        the distance.

Another list of examples follow:

Example 1

-   -   A robotic surgical system for treating a patient, the robotic        surgical system comprises a surgical tool movable relative to        the patient and a user input device comprising a base and a        controller movable relative to the base to effect a motion of        the surgical tool in response to a user input force. The robotic        surgical system further comprises a control circuit configured        to receive a user selection signal indicative of a selection        between a first motion scaling profile of the motion of the        surgical tool and a second motion scaling profile of the motion        of the surgical tool, receive a motion control signal from the        user input device indicative of a user input force, and cause        the surgical tool to be moved in response to the motion control        signal in accordance with the first motion scaling profile or        the second motion scaling profile based on the user selection        signal. The first motion scaling profile is different than the        second motion scaling profile.

Example 2

-   -   The robotic surgical system of Example 1, wherein the base is        stationary.

Example 3

-   -   The robotic surgical system of Examples 1 or 2, wherein the        selection is made using a dial.

Example 4

-   -   The robotic surgical system of Examples 1 or 2, wherein the        selection is made using a pedal assembly.

Example 5

-   -   The robotic surgical system of Examples 1 or 2, wherein the        selection is made using a touch screen.

Example 6

-   -   The robotic surgical system of any one of Examples 1-5, wherein        the user input device comprises a force sensor for measuring the        user input force.

Example 7

-   -   A robotic surgical system for treating a patient, the robotic        surgical system comprising a surgical tool movable relative to        the patient and a user input device comprising a base and a        controller movable relative to the base to effect a motion of        the surgical tool in response to a user input force. The robotic        surgical system further comprises a control circuit configured        to determine a distance between the surgical tool and the        patient, receive a motion control signal from the user input        device indicative of the user input force, and cause the        surgical tool to be moved in response to the motion control        signal in accordance with a first motion scaling profile of the        motion of the surgical tool or a second motion scaling profile        of the motion of the surgical tool based on the distance between        the surgical tool and the patient. The first motion scaling        profile is different than the second motion scaling profile.

Example 8

-   -   The robotic surgical system of Example 7, wherein determining        the distance between the surgical tool and the patient comprises        transmitting an electromagnetic wave from the surgical tool to        the patient and calculating a time-of-flight of the        electromagnetic wave reflected by the patient.

Example 9

-   -   The robotic surgical system of Example 7, wherein determining        the distance between the surgical tool and the patient comprises        receiving an input signal indicative of the distance.

Example 10

-   -   The robotic surgical system of any one of Examples 7-9, wherein        the control circuit is configured to compare the distance to a        threshold distance.

Example 11

-   -   The robotic surgical system of Example 10, wherein the control        circuit is configured to select the first motion scaling profile        if the distance is greater than or equal to the threshold        distance.

Example 12

-   -   The robotic surgical system of Example 10, wherein the control        circuit is configured to select the second motion scaling        profile if the distance is less than or equal to the threshold        distance.

Example 13

-   -   A robotic surgical system for treating a patient, the robotic        surgical system comprising a surgical tool and a user input        device configured to cause the surgical tool to move relative to        the patient in response to user input forces. The robotic        surgical system further comprise a control circuit configured to        receive a first motion control signal from the user input device        indicative of a first user input force, receive a second motion        control signal from the user input device indicative of a second        user input force different than the first user input force,        cause the surgical tool to be moved at a predetermined rate of        motion in response the first motion control signal, and cause        the surgical tool to be moved at the predetermined rate of        motion in response the second motion control signal.

Example 14

-   -   The robotic surgical system of Example 13, wherein the second        user input force is greater than the first user input force.

Example 15

-   -   The robotic surgical system of Examples 13 or 14, wherein the        control circuit is configured to cause the surgical tool to be        moved at the predetermined rate of motion in response the first        motion control signal in a gross motion mode of the user input        device.    -   Example 16    -   The robotic surgical system of any one of Examples 13-15,        wherein the control circuit is configured to cause the surgical        tool to be moved at the predetermined rate of motion in response        the second motion control signal in a fine motion mode of the        user input device.

Example 17

-   -   The robotic surgical system of any one of Examples 13-16,        wherein the user input device comprises a base and a controller        movable relative to the base in response to the user input        forces.

Example 18

-   -   The robotic surgical system of Example 17, wherein the base is        stationary.

Example 19

-   -   The robotic surgical system of any one of Examples 13-18,        wherein the user input device comprises a force sensor for        measuring the user input forces.

While several forms have been illustrated and described, it is not theintention of Applicant to restrict or limit the scope of the appendedclaims to such detail. Numerous modifications, variations, changes,substitutions, combinations, and equivalents to those forms may beimplemented and will occur to those skilled in the art without departingfrom the scope of the present disclosure. Moreover, the structure ofeach element associated with the described forms can be alternativelydescribed as a means for providing the function performed by theelement. Also, where materials are disclosed for certain components,other materials may be used. It is therefore to be understood that theforegoing description and the appended claims are intended to cover allsuch modifications, combinations, and variations as falling within thescope of the disclosed forms. The appended claims are intended to coverall such modifications, variations, changes, substitutions,modifications, and equivalents.

The foregoing detailed description has set forth various forms of thedevices and/or processes via the use of block diagrams, flowcharts,and/or examples. Insofar as such block diagrams, flowcharts, and/orexamples contain one or more functions and/or operations, it will beunderstood by those within the art that each function and/or operationwithin such block diagrams, flowcharts, and/or examples can beimplemented, individually and/or collectively, by a wide range ofhardware, software, firmware, or virtually any combination thereof.Those skilled in the art will recognize that some aspects of the formsdisclosed herein, in whole or in part, can be equivalently implementedin integrated circuits, as one or more computer programs running on oneor more computers (e.g., as one or more programs running on one or morecomputer systems), as one or more programs running on one or moreprocessors (e.g., as one or more programs running on one or moremicroprocessors), as firmware, or as virtually any combination thereof,and that designing the circuitry and/or writing the code for thesoftware and or firmware would be well within the skill of one of skillin the art in light of this disclosure. In addition, those skilled inthe art will appreciate that the mechanisms of the subject matterdescribed herein are capable of being distributed as one or more programproducts in a variety of forms, and that an illustrative form of thesubject matter described herein applies regardless of the particulartype of signal bearing medium used to actually carry out thedistribution.

Instructions used to program logic to perform various disclosed aspectscan be stored within a memory in the system, such as dynamic randomaccess memory (DRAM), cache, flash memory, or other storage.Furthermore, the instructions can be distributed via a network or by wayof other computer readable media. Thus a machine-readable medium mayinclude any mechanism for storing or transmitting information in a formreadable by a machine (e.g., a computer), but is not limited to, floppydiskettes, optical disks, compact disc, read-only memory (CD-ROMs), andmagneto-optical disks, read-only memory (ROMs), random access memory(RAM), erasable programmable read-only memory (EPROM), electricallyerasable programmable read-only memory (EEPROM), magnetic or opticalcards, flash memory, or a tangible, machine-readable storage used in thetransmission of information over the Internet via electrical, optical,acoustical or other forms of propagated signals (e.g., carrier waves,infrared signals, digital signals, etc.). Accordingly, thenon-transitory computer-readable medium includes any type of tangiblemachine-readable medium suitable for storing or transmitting electronicinstructions or information in a form readable by a machine (e.g., acomputer).

As used in any aspect herein, the term “control circuit” may refer to,for example, hardwired circuitry, programmable circuitry (e.g., acomputer processor including one or more individual instructionprocessing cores, processing unit, processor, microcontroller,microcontroller unit, controller, digital signal processor (DSP),programmable logic device (PLD), programmable logic array (PLA), orfield programmable gate array (FPGA)), state machine circuitry, firmwarethat stores instructions executed by programmable circuitry, and anycombination thereof. The control circuit may, collectively orindividually, be embodied as circuitry that forms part of a largersystem, for example, an integrated circuit (IC), an application-specificintegrated circuit (ASIC), a system on-chip (SoC), desktop computers,laptop computers, tablet computers, servers, smart phones, etc.Accordingly, as used herein “control circuit” includes, but is notlimited to, electrical circuitry having at least one discrete electricalcircuit, electrical circuitry having at least one integrated circuit,electrical circuitry having at least one application specific integratedcircuit, electrical circuitry forming a general purpose computing deviceconfigured by a computer program (e.g., a general purpose computerconfigured by a computer program which at least partially carries outprocesses and/or devices described herein, or a microprocessorconfigured by a computer program which at least partially carries outprocesses and/or devices described herein), electrical circuitry forminga memory device (e.g., forms of random access memory), and/or electricalcircuitry forming a communications device (e.g., a modem, communicationsswitch, or optical-electrical equipment). Those having skill in the artwill recognize that the subject matter described herein may beimplemented in an analog or digital fashion or some combination thereof.

As used in any aspect herein, the term “logic” may refer to an app,software, firmware and/or circuitry configured to perform any of theaforementioned operations. Software may be embodied as a softwarepackage, code, instructions, instruction sets and/or data recorded onnon-transitory computer readable storage medium. Firmware may beembodied as code, instructions or instruction sets and/or data that arehard-coded (e.g., nonvolatile) in memory devices.

As used in any aspect herein, the terms “component,” “system,” “module”and the like can refer to a computer-related entity, either hardware, acombination of hardware and software, software, or software inexecution.

As used in any aspect herein, an “algorithm” refers to a self-consistentsequence of steps leading to a desired result, where a “step” refers toa manipulation of physical quantities and/or logic states which may,though need not necessarily, take the form of electrical or magneticsignals capable of being stored, transferred, combined, compared, andotherwise manipulated. It is common usage to refer to these signals asbits, values, elements, symbols, characters, terms, numbers, or thelike. These and similar terms may be associated with the appropriatephysical quantities and are merely convenient labels applied to thesequantities and/or states.

A network may include a packet switched network. The communicationdevices may be capable of communicating with each other using a selectedpacket switched network communications protocol. One examplecommunications protocol may include an Ethernet communications protocolwhich may be capable permitting communication using a TransmissionControl Protocol/Internet Protocol (TCP/IP). The Ethernet protocol maycomply or be compatible with the Ethernet standard published by theInstitute of Electrical and Electronics Engineers (IEEE) titled “IEEE802.3 Standard”, published in December, 2008 and/or later versions ofthis standard. Alternatively or additionally, the communication devicesmay be capable of communicating with each other using an X.25communications protocol. The X.25 communications protocol may comply orbe compatible with a standard promulgated by the InternationalTelecommunication Union-Telecommunication Standardization Sector(ITU-T). Alternatively or additionally, the communication devices may becapable of communicating with each other using a frame relaycommunications protocol. The frame relay communications protocol maycomply or be compatible with a standard promulgated by ConsultativeCommittee for International Telegraph and Telephone (CCITT) and/or theAmerican National Standards Institute (ANSI). Alternatively oradditionally, the transceivers may be capable of communicating with eachother using an Asynchronous Transfer Mode (ATM) communications protocol.The ATM communications protocol may comply or be compatible with an ATMstandard published by the ATM Forum titled “ATM-MPLS NetworkInterworking 2.0” published August 2001, and/or later versions of thisstandard. Of course, different and/or after-developedconnection-oriented network communication protocols are equallycontemplated herein.

Unless specifically stated otherwise as apparent from the foregoingdisclosure, it is appreciated that, throughout the foregoing disclosure,discussions using terms such as “processing,” “computing,”“calculating,” “determining,” “displaying,” or the like, refer to theaction and processes of a computer system, or similar electroniccomputing device, that manipulates and transforms data represented asphysical (electronic) quantities within the computer system's registersand memories into other data similarly represented as physicalquantities within the computer system memories or registers or othersuch information storage, transmission or display devices.

One or more components may be referred to herein as “configured to,”“configurable to,” “operable/operative to,” “adapted/adaptable,” “ableto,” “conformable/conformed to,” etc. Those skilled in the art willrecognize that “configured to” can generally encompass active-statecomponents and/or inactive-state components and/or standby-statecomponents, unless context requires otherwise.

The terms “proximal” and “distal” are used herein with reference to aclinician manipulating the handle portion of the surgical instrument.The term “proximal” refers to the portion closest to the clinician andthe term “distal” refers to the portion located away from the clinician.It will be further appreciated that, for convenience and clarity,spatial terms such as “vertical”, “horizontal”, “up”, and “down” may beused herein with respect to the drawings. However, surgical instrumentsare used in many orientations and positions, and these terms are notintended to be limiting and/or absolute.

Those skilled in the art will recognize that, in general, terms usedherein, and especially in the appended claims (e.g., bodies of theappended claims) are generally intended as “open” terms (e.g., the term“including” should be interpreted as “including but not limited to,” theterm “having” should be interpreted as “having at least,” the term“includes” should be interpreted as “includes but is not limited to,”etc.). It will be further understood by those within the art that if aspecific number of an introduced claim recitation is intended, such anintent will be explicitly recited in the claim, and in the absence ofsuch recitation no such intent is present. For example, as an aid tounderstanding, the following appended claims may contain usage of theintroductory phrases “at least one” and “one or more” to introduce claimrecitations. However, the use of such phrases should not be construed toimply that the introduction of a claim recitation by the indefinitearticles “a” or “an” limits any particular claim containing suchintroduced claim recitation to claims containing only one suchrecitation, even when the same claim includes the introductory phrases“one or more” or “at least one” and indefinite articles such as “a” or“an” (e.g., “a” and/or “an” should typically be interpreted to mean “atleast one” or “one or more”); the same holds true for the use ofdefinite articles used to introduce claim recitations.

In addition, even if a specific number of an introduced claim recitationis explicitly recited, those skilled in the art will recognize that suchrecitation should typically be interpreted to mean at least the recitednumber (e.g., the bare recitation of “two recitations,” without othermodifiers, typically means at least two recitations, or two or morerecitations). Furthermore, in those instances where a conventionanalogous to “at least one of A, B, and C, etc.” is used, in generalsuch a construction is intended in the sense one having skill in the artwould understand the convention (e.g., “a system having at least one ofA, B, and C” would include but not be limited to systems that have Aalone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). In those instances where aconvention analogous to “at least one of A, B, or C, etc.” is used, ingeneral such a construction is intended in the sense one having skill inthe art would understand the convention (e.g., “a system having at leastone of A, B, or C” would include but not be limited to systems that haveA alone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). It will be furtherunderstood by those within the art that typically a disjunctive wordand/or phrase presenting two or more alternative terms, whether in thedescription, claims, or drawings, should be understood to contemplatethe possibilities of including one of the terms, either of the terms, orboth terms unless context dictates otherwise. For example, the phrase “Aor B” will be typically understood to include the possibilities of “A”or “B” or “A and B.”

With respect to the appended claims, those skilled in the art willappreciate that recited operations therein may generally be performed inany order. Also, although various operational flow diagrams arepresented in a sequence(s), it should be understood that the variousoperations may be performed in other orders than those which areillustrated, or may be performed concurrently. Examples of suchalternate orderings may include overlapping, interleaved, interrupted,reordered, incremental, preparatory, supplemental, simultaneous,reverse, or other variant orderings, unless context dictates otherwise.Furthermore, terms like “responsive to,” “related to,” or otherpast-tense adjectives are generally not intended to exclude suchvariants, unless context dictates otherwise.

It is worthy to note that any reference to “one aspect,” “an aspect,”“an exemplification,” “one exemplification,” and the like means that aparticular feature, structure, or characteristic described in connectionwith the aspect is included in at least one aspect. Thus, appearances ofthe phrases “in one aspect,” “in an aspect,” “in an exemplification,”and “in one exemplification” in various places throughout thespecification are not necessarily all referring to the same aspect.Furthermore, the particular features, structures or characteristics maybe combined in any suitable manner in one or more aspects.

Any patent application, patent, non-patent publication, or otherdisclosure material referred to in this specification and/or listed inany Application Data Sheet is incorporated by reference herein, to theextent that the incorporated materials is not inconsistent herewith. Assuch, and to the extent necessary, the disclosure as explicitly setforth herein supersedes any conflicting material incorporated herein byreference. Any material, or portion thereof, that is said to beincorporated by reference herein, but which conflicts with existingdefinitions, statements, or other disclosure material set forth hereinwill only be incorporated to the extent that no conflict arises betweenthat incorporated material and the existing disclosure material.

In summary, numerous benefits have been described which result fromemploying the concepts described herein. The foregoing description ofthe one or more forms has been presented for purposes of illustrationand description. It is not intended to be exhaustive or limiting to theprecise form disclosed. Modifications or variations are possible inlight of the above teachings. The one or more forms were chosen anddescribed in order to illustrate principles and practical application tothereby enable one of ordinary skill in the art to utilize the variousforms and with various modifications as are suited to the particular usecontemplated. It is intended that the claims submitted herewith definethe overall scope.

What is claimed is:
 1. A surgical system, comprising: a surgical tool; amotor operably coupled to the surgical tool; and a control circuitcoupled to the motor, wherein the control circuit is configured to:receive an instrument motion control signal indicative of a user input;cause the motor to move the surgical tool in response to the instrumentmotion control signal; receive an input signal indicative of a distancebetween the surgical tool and tissue; and scale the movement of thesurgical tool to the user input in accordance with the input signal. 2.The surgical system of claim 1, wherein the control circuit isconfigured to scale the movement of the surgical tool to the user inputwhile the distance is greater than or equal to a threshold.
 3. Thesurgical system of claim 2, wherein the control circuit is configured todeactivate the scaling of the movement of the surgical tool to the userinput when the distance is below the threshold.
 4. The surgical systemof claim 2, wherein the threshold is a first threshold, and wherein thecontrol circuit is configured to adjust the scaling in accordance withthe distance while the distance is between the first threshold and asecond threshold.
 5. The surgical system of claim 1, wherein the controlcircuit is configured to determine the distance between the surgicaltool and the tissue by: causing a transmission of an electromagneticwave from the surgical tool to the tissue; and calculating atime-of-flight of the electromagnetic wave reflected by the tissue. 6.The surgical system of claim 1, further comprising an input controldevice configured to transmit the instrument motion control signal tothe control circuit.
 7. The surgical system of claim 6, wherein theinput control device comprises a sensor for measuring a parameter of theuser input.
 8. The surgical system of claim 7, wherein the sensor is aforce sensor, and wherein the parameter is a force applied to the inputcontrol device.
 9. The surgical system of claim 1, wherein scaling themovement of the surgical tool comprises adjusting a force required tomove the surgical tool at a given speed.
 10. A surgical system,comprising: a surgical tool; a motor operably coupled to the surgicaltool; and a control circuit coupled to the motor, wherein the controlcircuit is configured to: receive an instrument motion control signalindicative of a user input; cause the motor to move the surgical tool inresponse to the instrument motion control signal; determine a distancebetween the surgical tool and tissue; and scale the movement of thesurgical tool to the user input in accordance with the distance.
 11. Thesurgical system of claim 10, wherein the control circuit is configuredto scale the movement of the surgical tool to the user input while thedistance is greater than or equal to a threshold.
 12. The surgicalsystem of claim 11, wherein the control circuit is configured todeactivate the scaling of the movement of the surgical tool to the userinput when the distance is below the threshold.
 13. The surgical systemof claim 11, wherein the threshold is a first threshold, and wherein thecontrol circuit is configured to adjust the scaling in accordance withthe distance while the distance is between the first threshold and asecond threshold.
 14. The surgical system of claim 10, whereindetermining the distance between the surgical tool and the tissuecomprises: causing a transmission of an electromagnetic wave from thesurgical tool to the tissue; and calculating a time-of-flight of theelectromagnetic wave reflected by the tissue.
 15. The surgical system ofclaim 10, further comprising an input control device configured totransmit the instrument motion control signal to the control circuit.16. The surgical system of claim 15, wherein the input control devicecomprises a sensor for measuring a parameter of the user input.
 17. Thesurgical system of claim 16, wherein the sensor is a force sensor, andwherein the parameter is a force applied to the input control device.18. A surgical system, comprising: a surgical tool; a motor operablycoupled to the surgical tool; and a control circuit coupled to themotor, wherein the control circuit is configured to: receive aninstrument motion control signal indicative of a user input; cause themotor to move the surgical tool in response to the instrument motioncontrol signal; receive an input signal indicative of a distance betweenthe surgical tool and tissue; and select between a gross motion mode anda fine motion mode of the surgical tool based on distance between thesurgical tool and the tissue.
 19. The surgical system of claim 18,wherein the control circuit is configured to select the gross motionmode when the input signal is indicative of a distance greater than orequal to a threshold.
 20. The surgical system of claim 18, wherein thecontrol circuit is configured to select the fine motion mode when theinput signal is indicative of a distance less than or equal to athreshold.